ventral incisional hernia repair

BABS37

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311
Location
Des Moines
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I just want to make sure I have the right codes for this procedure. It sounds like he started out as an open procedure, then went to laparoscopic for the cholecystectomy, where he finished up the loose ends from the hernia repair. I'm thinking 47562 and 49561 but not sure.
Do you think maybe the OP note just got written wrong by the transcriptionist??? It's just weird to me.

Any takers?

laparoscopic cholecystectomy with ventral incisional initial hernia repair

...the abdomen was preppred and draped. A vertical midline incision was made around the umbilicus. Subcutaneous tissue was divided. A moderately large hernia was identified and dissected out down to the fascial level. The fascial defect was approx. 3-4cm in diameter and a small hole was made in the sac. 0 vacryl purse string suture was placed around the hole. A 10 mm port was inserted. Vicryl purse string was tied down t maintain seal around the trocar and pneumoperitoneum was obtained. A 5mm epigastric trocar and 2mm right upper quadrant micro grasper were inserted and gallbladder was grasped at its apex and retracted superolaterally. Peritoneum around the base of the gallbladder was striped down skeletonizing the cystic duct and artery. Four clips were placed on the duct and two on the artery. Each was then divided between the two clips proximal to the gallbladder leaving three on the duct and one on the artery. The gallbladder was separated from the liver with electrocautery without bile spillage and removed from the hole port site. Right upper quadrant was thoroughly examined and hemostasis was confirmed. Following this the incisional hernia repair was undertaken. Surrounding the fascial defect the fascia was cleaned off 1-2 cm in all directions to allow exposure back to get healthy fascia. Because of the biliary operation elected not to place mesh. The fascia was approx. in the midline under minimal tension with interrupted 0 nurolon figure of eight sutures. SKin was closed at all locations...
 
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227
Location
Nashville
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Since the hernia had to be repaired in order to do the lap chole, it can't be separately coded if I'm correct. I would add a -22 modifier.

Thoughts anyone?
 
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