Can anyone help me with this one. I know the code for the incisional hernia repair but I am struggling with the fistula resection. It is from a previous suprapubic urinary catheter so I found 51880 but am unsure if this is ok to bill since no repair was done to the bladder. Below is the Op note.
After operative anesthesia and site was verified, the patient
was taken to the operating room and placed in supine position on the
operating table. General endotracheal anesthesia instituted. Abdomen was
prepped and draped sterilely. Dr._________ had positioned the Foley
appropriately into the urethra. I exchanged that and irrigated. The
fistula tract appears to have closed, although was still easily visible. A
midline incision made _____ make an elliptical incision around the fistula
tract at the skin, carried down through subcutaneous tissue and the hernia
sac was identified with the bladder diverticulum there. The anterior
fascial edges were freed and there was seemed to be the hernia defect
measured 2.5 cm in greatest dimension. The rectus muscles posteriorly were
identified and elevated off of bladder circumferentially, hernia sac that
was excised as well as the old fistula tract. There was no leakage of the
bladder diverticulum despite filling the bladder fully with the Foley
catheter. Once the bladder was fully explored by Dr._______, it was dropped
back in the abdominal cavity. The peritoneal surface was then closed with
a running 3-0 Polysorb. Due to the previous hernia repair and old mesh
being placed adjacent to the bladder, this was decided to close this
primarily without new mesh. Despite the increased risk of hernia
recurrence, this was done to prevent further bladder complication. The
rectus muscles were then approximated using a running 3-0 Vicryl, fascia
was closed with #1 PDS started superiorly, #1 PDS started inferiorly.
These were run in the middle incision and tied together primarily closing
fascial defect. The wound was irrigated with sterile solution. Skin _____
was closed with 4-0 Biosyn in subcuticular fashion. Indermil skin glue
applied.
After operative anesthesia and site was verified, the patient
was taken to the operating room and placed in supine position on the
operating table. General endotracheal anesthesia instituted. Abdomen was
prepped and draped sterilely. Dr._________ had positioned the Foley
appropriately into the urethra. I exchanged that and irrigated. The
fistula tract appears to have closed, although was still easily visible. A
midline incision made _____ make an elliptical incision around the fistula
tract at the skin, carried down through subcutaneous tissue and the hernia
sac was identified with the bladder diverticulum there. The anterior
fascial edges were freed and there was seemed to be the hernia defect
measured 2.5 cm in greatest dimension. The rectus muscles posteriorly were
identified and elevated off of bladder circumferentially, hernia sac that
was excised as well as the old fistula tract. There was no leakage of the
bladder diverticulum despite filling the bladder fully with the Foley
catheter. Once the bladder was fully explored by Dr._______, it was dropped
back in the abdominal cavity. The peritoneal surface was then closed with
a running 3-0 Polysorb. Due to the previous hernia repair and old mesh
being placed adjacent to the bladder, this was decided to close this
primarily without new mesh. Despite the increased risk of hernia
recurrence, this was done to prevent further bladder complication. The
rectus muscles were then approximated using a running 3-0 Vicryl, fascia
was closed with #1 PDS started superiorly, #1 PDS started inferiorly.
These were run in the middle incision and tied together primarily closing
fascial defect. The wound was irrigated with sterile solution. Skin _____
was closed with 4-0 Biosyn in subcuticular fashion. Indermil skin glue
applied.
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