Marcela72
Contributor
Hello,
Can I get some help with this? What was coded was 49595 w/15734-22. I don't agree with this coding. I am getting 49595-22 w/49905. I would greatly appreciate the feedback.
An elliptical upper midline incision was made and the old scar was excised. The skin and soft tissues were dissected down to the level of the hernia sac, which was then circumferentially dissected off fascia laterally in both directions until the abdomen was entered. There were adhesions tethering mesentery along with small bowel and colon to anterior abdominal wall. An extensive and meticulous adhesiolysis was performed to fully mobilize bowel, which took over an hour to perform. At one point, one serosal tear at the transverse colon was appreciated and intrinsic to this dissection, which was repaired in a series of 3-0 Vicryl imbricated stitches. Once the bowel was fully mobilized, the entirety of the small bowel from the ligament of Treitz was ran distally to the ileocecal valve. There was one area of nodularity in the jejunal mesentery, which was excised and sent for frozen section. An additional nodule was noted on transverse colon epiploic fat which was also excised and sent for frozen section. Both frozen sections were negative for malignancy. At this point the hernia sac was fully dissected off fascia until healthy fascia was visible, excised, and sent for permanent pathology. Both of the two hernia defects were incorporated into one larger fascial defect which measured about 15 cm in length. The abdomen was thoroughly irrigated and noted to be hemostatic.
Attention was then turned towards creating bilateral rectus abdominis myofascial flaps in order to fill the hernia defect and accomplish a structurally sound abdominal wall reconstruction. This also allowed for a retrorectus mesh placement. The linea alba on the left was incised and the retrorectus space anterior to the posterior sheath was entered. This plane was developed and myofascial flaps were raised on the left for the entirety of the incision. This process was then repeated on the right. The posterior rectus sheath was closed using a series of interrupted #1 Vicryls. A large Gore Bio-A mesh was then placed on top of the posterior sheath. The bilateral myofascial flaps were advanced to position overlying the mesh placement and secured in place with interrupted closure of the anterior rectus sheath with a series of interrupted #1 Vicryls. The wound was again thoroughly irrigated and noted to be hemostatic. A complex closure of the 18cm soft tissue defect was the performed in two layers using a series of interrupted 3-0 Vicryls and skin was closed using staples. The incision was dressed with a Mepilex dressing.
Can I get some help with this? What was coded was 49595 w/15734-22. I don't agree with this coding. I am getting 49595-22 w/49905. I would greatly appreciate the feedback.
An elliptical upper midline incision was made and the old scar was excised. The skin and soft tissues were dissected down to the level of the hernia sac, which was then circumferentially dissected off fascia laterally in both directions until the abdomen was entered. There were adhesions tethering mesentery along with small bowel and colon to anterior abdominal wall. An extensive and meticulous adhesiolysis was performed to fully mobilize bowel, which took over an hour to perform. At one point, one serosal tear at the transverse colon was appreciated and intrinsic to this dissection, which was repaired in a series of 3-0 Vicryl imbricated stitches. Once the bowel was fully mobilized, the entirety of the small bowel from the ligament of Treitz was ran distally to the ileocecal valve. There was one area of nodularity in the jejunal mesentery, which was excised and sent for frozen section. An additional nodule was noted on transverse colon epiploic fat which was also excised and sent for frozen section. Both frozen sections were negative for malignancy. At this point the hernia sac was fully dissected off fascia until healthy fascia was visible, excised, and sent for permanent pathology. Both of the two hernia defects were incorporated into one larger fascial defect which measured about 15 cm in length. The abdomen was thoroughly irrigated and noted to be hemostatic.
Attention was then turned towards creating bilateral rectus abdominis myofascial flaps in order to fill the hernia defect and accomplish a structurally sound abdominal wall reconstruction. This also allowed for a retrorectus mesh placement. The linea alba on the left was incised and the retrorectus space anterior to the posterior sheath was entered. This plane was developed and myofascial flaps were raised on the left for the entirety of the incision. This process was then repeated on the right. The posterior rectus sheath was closed using a series of interrupted #1 Vicryls. A large Gore Bio-A mesh was then placed on top of the posterior sheath. The bilateral myofascial flaps were advanced to position overlying the mesh placement and secured in place with interrupted closure of the anterior rectus sheath with a series of interrupted #1 Vicryls. The wound was again thoroughly irrigated and noted to be hemostatic. A complex closure of the 18cm soft tissue defect was the performed in two layers using a series of interrupted 3-0 Vicryls and skin was closed using staples. The incision was dressed with a Mepilex dressing.