If patient comes to the ER with incarcerated possibly strangulated umbilical hernia, do we code for the laparotomy and reduction of hernia 44050 or the hernia repair. There is some confusion as just a hernia repair typically doesn't require a laparotomy.
POSTOPERATIVE DIAGNOSIS:
1. Strangulated umbilical hernia
2. Small bowel obstruction
PROCEDURE PERFORMED:
1. Exploratory laparotomy
2. Abdominal washout
3. Open incarcerated umbilical hernia repair
presented with incarcerated possibly strangulated umbilical hernia. Risks and benefits were discussed including but not limited to infection, pain, bleeding, PE, DVT, arrhythmia, stroke, death, allergic reaction, anastomotic breakdown, bowel perforation, and others.
DETAILS OF PROCEDURE: After obtaining informed consent, the patient was taken to the operating room, and placed on the operating table in the supine position. After induction of adequate general anesthesia, the patient's abdomen is prepped and draped in a standard sterile fashion. A time-out was performed, with the patient's name, operation to be performed, and operative site all positively identified.
A #15 scalpel was used to make a midline laparotomy. Bovie electrocautery was used to dissect down to the level of the fascia. The fascia was grasped with coker clamps and elevated. This was cut with scissors and the peritoneal cavity was entered safely. The laparotomy was opened along its length with electrocautery with care taken to avoid injury to underlying structures. A LOOP OF SMALL BOWEL WAS INCARCERATED INTO THE UMBILICAL HERNIA DEFECT. IT WAS GENTLY REDUCED. The bowel wall was erythematous but viable. The enteric contents were milked through this area into the distal small bowel and into the cecum. The entire small bowel was run from Ligament of Treitz to terminal ileum. There was diffuse petechial hemorrhages noted throughout the small bowel mesentery. No areas of bowel ischemia were noted. The umbilical hernia sac was excised with electrocautery. The hernia sac was erythematous and edematous with patchy ischemia. The hernia defect measured 5 cm.
The abdominal cavity was irrigated with copious volume of warm saline and hemostasis was noted. The abdominal wall was closed with looped 0 PDS in the fascial layer x 2 incorporating the umbilical hernia. They met in the middle and tied together. The dermis was closed with 3-0 Vicryl in simple interrupted manner. The umbilical stalk was tacked down to the fascia with 3-0 Vicryl. The skin was stapled close
POSTOPERATIVE DIAGNOSIS:
1. Strangulated umbilical hernia
2. Small bowel obstruction
PROCEDURE PERFORMED:
1. Exploratory laparotomy
2. Abdominal washout
3. Open incarcerated umbilical hernia repair
presented with incarcerated possibly strangulated umbilical hernia. Risks and benefits were discussed including but not limited to infection, pain, bleeding, PE, DVT, arrhythmia, stroke, death, allergic reaction, anastomotic breakdown, bowel perforation, and others.
DETAILS OF PROCEDURE: After obtaining informed consent, the patient was taken to the operating room, and placed on the operating table in the supine position. After induction of adequate general anesthesia, the patient's abdomen is prepped and draped in a standard sterile fashion. A time-out was performed, with the patient's name, operation to be performed, and operative site all positively identified.
A #15 scalpel was used to make a midline laparotomy. Bovie electrocautery was used to dissect down to the level of the fascia. The fascia was grasped with coker clamps and elevated. This was cut with scissors and the peritoneal cavity was entered safely. The laparotomy was opened along its length with electrocautery with care taken to avoid injury to underlying structures. A LOOP OF SMALL BOWEL WAS INCARCERATED INTO THE UMBILICAL HERNIA DEFECT. IT WAS GENTLY REDUCED. The bowel wall was erythematous but viable. The enteric contents were milked through this area into the distal small bowel and into the cecum. The entire small bowel was run from Ligament of Treitz to terminal ileum. There was diffuse petechial hemorrhages noted throughout the small bowel mesentery. No areas of bowel ischemia were noted. The umbilical hernia sac was excised with electrocautery. The hernia sac was erythematous and edematous with patchy ischemia. The hernia defect measured 5 cm.
The abdominal cavity was irrigated with copious volume of warm saline and hemostasis was noted. The abdominal wall was closed with looped 0 PDS in the fascial layer x 2 incorporating the umbilical hernia. They met in the middle and tied together. The dermis was closed with 3-0 Vicryl in simple interrupted manner. The umbilical stalk was tacked down to the fascia with 3-0 Vicryl. The skin was stapled close