need help coding spinal exposure


Maywood, IL
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Please help me with coding this procedure. Our surgeon titled this procedure "Spinal exposure with umbilical hernia repair". But, I am wondering if it's appropriate to only code the umbilical hernia repair in this situation. :confused:

OPERATIVE PROCEDURE: After the patient was intubated and positioned by Dr. A the abdomen was prepped and draped in the usual sterile fashion. A vertical midline incision was made from the symphysis pubis to his umbilicus. The umbilical hernia was included in the midline incision. The Omni tract retractor was placed was placed retractin the bowel and the colon out of the way exposing the L5-S1 disc space. We dissected into the retroperitoneum. We identified the sympathetic nerve, the right hypogastric nerve and retracted this with the colon. We identified the middle savral vessels. Actually the middle sacral vein was very lage approximating 4 to 5 mm in diameter. We dissected further to identify both the left and right iliac arteries and veins to ensure that we were ligating the appropriate structures. After this was confirmed the middle sacral artery and vein were ligated and divided with 2-0 silk ties. Blunt dissection was used to dissect the artery and vein off of the L5-S1 disc space identifying the midline for Dr. ~. Dr. ~ then will complete his portion of the dictation after this exposure. After Dr. ~ his instrumentation and plating the patient's abdomen was irrigated and inspected and seen to be hemostatic. There were no bleeding points seen. No injuries to the small bowel or colon were created. The retroperitoneum was closed with a running 3-0 Cicryl. The omentum was draped over the viscera and the fascia was closed using a ruuning #1 looped PDS suture. The skin and subcutaneous tissues were irrigated and made hemostatic using electrocautery and the skin was closed with surgical clips. Dry dressings were placed. The patient was allowed to awaken, extubated and taken to the recovery room in stable condition having tolerated the procedure well.

In this situation, is 49585 the only code I can use? I know I can't use 49010 because of that being included in the 22558 code. Could I use 22558-52? Is there another code? I'm confused. Any help or input would be appreciated. Thank you in advance.



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I'd suggested 22558-62. See guidelines before 22548. Dr is doing a distinct part(s) (Approach & Closure) of 22558. Hernia was part of the approach and the closure so no additional coding for that is needed.

Good Luck!