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Ventral hernia repair w/excision xiphoid tip and removal of Prolene suture in fascia

  1. #1
    Unhappy Ventral hernia repair w/excision xiphoid tip and removal of Prolene suture in fascia
    Medical Coding Books
    I am really hoping someone out there can tell me if they agree with code selection or make suggestions. The operative summary is attached.
    I'm thinking 49560 49568 21620 (xiphoid tip resection)
    but what about the sutures---foreign body removal 10121? 49402? included?

    Procedure summary: The patient's lesion was marked out preoperatively. It was in the high epigastric region. The patient's previous incision was opened and carried down to the underlying fascia. Fatty tissue was dissected free from the fascia throughout this area freeing up the anterior surface of the fascia. This was started inferiorly and extended superiorly. There were nodules consistent with a Prolene knot and loose Prolene suture with some interrupted Prolene. There was also a long running Prolene which apparently had snapped and was easily simply pulled out. The running Prolene did extend up to a knot by the xiphoid region that was very loose. This Prolene was removed. Another interrupted Prolene was removed. There was scar around the Prolene. The fascia was opened up from inferior to superior until a region about 1 cm with surrounding properitoneal fat. This was protruding through a small defect in the fascia. The properitoneal fat was freed up and there was a hard nodule protruding through the fascial defect. The defect was trimmed and opened up and the nodule dissected free from surrounding structures along with the herniated adjacent fat. This was a small 1 cm nodule. This was freed up and proved to be the tip of the patient's xiphoid. It became apparent that the patient's fascial opening had opened up superiorly where the Prolene suture was very loose. The tip of the xiphoid had herniated through along with a rim of properitoneal fat. The tip of the xiphoid and properitoneal fat were dissected free. The hernia edges were freed up. The tip of the xiphoid was resected with heavy scissors with just the very tip that was protruding through the hernia defect resected. The stump was rounded with a rongeur and a rasp. A piece of Prolite polypropylene mesh was placed posteriorly in the properitoneal space but anterior to the protruding xiphoid. The fascia was then closed anterior to the piece of mesh running the superior and inferior stitches through the mesh to anchor it in place posterior to the repair.

  2. #2
    nothing for sutures I would think....".very easily pulled out"

  3. #3
    Thanks again! You replied to two of my sugery "problems". I really appreciate.

  4. #4
    no problem..............I enjoy helping!

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