Would CPT CODE 49505-52 modifier be correct to use here since this was still hernia repair attempt?
Pre-op Diagnosis: Right inguinal hernia
Post-op Diagnosis:
No obvious inguinal hernia
Procedure(s) (Description):
Right inguinal mesh placement
Findings: No obvious right inguinal hernia. Possible preperitoneal fat extending down into the inguinal canal
Specimen(s) Type: None
Estimated Blood Loss: Less than 5 mL
The patient was brought to the operating room and placed in supine position and given general anesthesia. He received preoperative IV antibiotics, placement of sequential compression devices. His abdomen and inguinal regions were prepped and draped in a sterile manner. A Veress needle was used at Palmer's point in the left upper abdomen to obtain pneumoperitoneum to 15 mmHg. 5 mm Optiview trocar was placed approximately 8 cm above the umbilicus in the midline. An 8 mm port was placed in the right upper quadrant and another 1 in the left upper quadrant under direct visualization. The 5 mm Optiview was then replaced with an 8 mm port. All the port sites were infiltrated with a mixture of quarter percent Marcaine with epinephrine and Exparel. The patient was placed in Trendelenburg position. At this point the surgeon went to the operative console.
Looking down in the pelvis there was no peritoneal indentation on either the right or left inguinal area as one. Would expect with an inguinal hernia the peritoneum was opened horizontally above the right inguinal region and then bluntly separated from preperitoneal structures medially all the way down to cooper's ligament. This was extended laterally over to the inguinal canal and further lateral out on the abdominal wall. At the orifice of the inguinal canal there was a generous amount of preperitoneal fat extending slightly down into the inguinal canal. This was bluntly dissected away from the cord structures. Size medium 3D max mesh was placed into the abdomen. It was sutured at 3 locations with 0 Ethibond suture. 1 at cooper's ligament medially second suture on the superior edge medially and a third 1 on the superior edge laterally. This mesh covered the inguinal region and the bottom edge situated below the inguinal canal. The previously opened peritoneum was then closed using double-armed running STRATAFIX suture. Pneumoperitoneum was released. The surgeon scrubbed back into the case. The skin at the 3 trocar sites was closed using interrupted 5-0 plain gut suture along with Steri-Strip. Prior to extubation Valsalva maneuver was performed. There is no evidence for hernia in either inguinal region and no swelling of the scrotum from the pneumoperitoneum. He went to recovery in stable condition.
Pre-op Diagnosis: Right inguinal hernia
Post-op Diagnosis:
No obvious inguinal hernia
Procedure(s) (Description):
Right inguinal mesh placement
Findings: No obvious right inguinal hernia. Possible preperitoneal fat extending down into the inguinal canal
Specimen(s) Type: None
Estimated Blood Loss: Less than 5 mL
The patient was brought to the operating room and placed in supine position and given general anesthesia. He received preoperative IV antibiotics, placement of sequential compression devices. His abdomen and inguinal regions were prepped and draped in a sterile manner. A Veress needle was used at Palmer's point in the left upper abdomen to obtain pneumoperitoneum to 15 mmHg. 5 mm Optiview trocar was placed approximately 8 cm above the umbilicus in the midline. An 8 mm port was placed in the right upper quadrant and another 1 in the left upper quadrant under direct visualization. The 5 mm Optiview was then replaced with an 8 mm port. All the port sites were infiltrated with a mixture of quarter percent Marcaine with epinephrine and Exparel. The patient was placed in Trendelenburg position. At this point the surgeon went to the operative console.
Looking down in the pelvis there was no peritoneal indentation on either the right or left inguinal area as one. Would expect with an inguinal hernia the peritoneum was opened horizontally above the right inguinal region and then bluntly separated from preperitoneal structures medially all the way down to cooper's ligament. This was extended laterally over to the inguinal canal and further lateral out on the abdominal wall. At the orifice of the inguinal canal there was a generous amount of preperitoneal fat extending slightly down into the inguinal canal. This was bluntly dissected away from the cord structures. Size medium 3D max mesh was placed into the abdomen. It was sutured at 3 locations with 0 Ethibond suture. 1 at cooper's ligament medially second suture on the superior edge medially and a third 1 on the superior edge laterally. This mesh covered the inguinal region and the bottom edge situated below the inguinal canal. The previously opened peritoneum was then closed using double-armed running STRATAFIX suture. Pneumoperitoneum was released. The surgeon scrubbed back into the case. The skin at the 3 trocar sites was closed using interrupted 5-0 plain gut suture along with Steri-Strip. Prior to extubation Valsalva maneuver was performed. There is no evidence for hernia in either inguinal region and no swelling of the scrotum from the pneumoperitoneum. He went to recovery in stable condition.