Ventral Hernia Repair

cnramsey

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When I work this procedure up I am only getting 49561 and 49568. The other coder is coming up with 49566 and 49568. I haven't been able to get a hold of the surgeon yet but the provider that sent the patient to him said this was and inital not a recurrent. Plus I the surgeon does not say repair of recurrent. I will attach the consult code and the op note. Hope this helps.

Date\
BRIEF HISTORY: A 51-year-old is sent on referral from Dr A for surgical evaluation of a symptomatic ventral hernia. This gentleman has had a previous umbilical hernia repair over the past year. He has noted pain and swelling in the abdomen just above the umbilicus at a midline location which has caused concern.

PAST MEDICAL HISTORY

MEDICAL ILLNESSES: None.
PRIOR SURGERIES: Umbilical hernia repair at age .

CURRENT MEDICATIONS: None.

ALLERGIES: None.

SOCIAL HISTORY: He denies tobacco use. He does drink socially. He is a
EXAMINATION
VITAL SIGNS: Blood pressure 150/90, pulse 88. His weight is 396 and his height is _feet representing a body-mass index of 54.
CHEST: Clear to auscultation.
CARDIOVASCULAR: Regular rate and rhythm.
ABDOMEN: Morbidly obese and soft. There was a hernia mass palpable in the midline of the abdomen just above the umbilicus. Hernia contents measure about 10 cm in diameter. He has a healed, transversely oriented, infraumbilical, hernia scar.

IMPRESSION: Symptomatic ventral hernia (epigastric hernia).

PLAN: Ventral hernia repair. Discussed the procedure in detail. He understands and wishes to proceed.

*******************************************************
PREOPERATIVE DIAGNOSES
1. Chronically incarcerated ventral hernia.
2. Morbid obesity (body mass index 54).

POSTOPERATIVE DIAGNOSES
1. Chronically incarcerated ventral hernia.
2. Morbid obesity (body mass index 54).

PROCEDURE: Ventral hernia repair with Prolene mesh.

SURGEON:
ANESTHESIA: General.

DESCRIPTION OF PROCEDURE: The patient was taken to the operative suite and
placed in the supine position. Upon satisfactory general anesthesia the
patient's abdomen was prepped and draped in a sterile fashion. Ten
milliliters of half-percent Marcaine with epinephrine were used as a local
anesthetic. The hernia mass was palpable in the midline just above the
umbilicus. A midline incision was carried out and carried down adjacent to
the umbilicus. Dissection was carried down sharply using the cautery. A
hernia sac was encountered in the subcutaneous tissue. The hernia sac was
dissected circumferentially down to the anterior rectus fascia. The fascial
edges were cleared in all directions. About a centimeter beyond the fascial
defect an incision was carried out into the anterior rectus fascia developing
the retromuscular plane along each side of the hernia defect. Once the
retromuscular plane was developed in all directions the hernia sac was opened.
The incarcerated contents consisted of omentum. Sharply the omentum was
dissected from the sac. Excess omentum was amputated by the dividing it
between clamps and tying with 0 Vicryl. The amputated portion of the omentum
was discarded. The stump was allowed to retract into the peritoneal cavity.
The hernia sac including the posterior rectus sheath was closed in a single
layer with a running #1 Prolene suture. Once the retromuscular space was
fully developed, measurements were taken. The mesh that was used consisted of
a large piece of Prolene that was trimmed into a 15 x 10 cm oval patch. It
was placed into the retromuscular space overlying the posterior sheath. It
was tacked circumferentially up through the muscle and anterior sheath with
multiple, circumferentially placed, 0 Vicryl, horizontal, mattress sutures
marking all the cardinal points. A 10 mm Jackson-Pratt drain was left exiting
the skin through an inferior stab wound. The subcutaneous tissue was closed
in layers with interrupted 3-0 Vicryl sutures. The skin was closed with
interrupted 4-0 Monocryl subcuticular sutures as well as staples. The
Jackson-Pratt drain was secured with 3-0 Vicryl suture. Sterile dressings
were applied. The patient was transported back to the recovery room in stable
condition.



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JSYLVAIN

Contributor
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Need to discuss with surgeon, it is mentioned in op note,
The hernia mass was palpable in the midline just above the
umbilicus. A midline incision was carried out and carried down adjacent to
the umbilicus.
Could be considered recurrent due to location of ventral hernia is adjacent to umbilicus.
 
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This is a recurrent hernia. Ask your doc and he'll confirm it. Adjacent will be included in the umbilical hernia and if that's the only surgery he's had before then by definition it has to be a recurrent hernia.
 
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