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Thread: help with unusual hernia repair

  1. #1

    Default help with unusual hernia repair

    AAPC: Back to School
    The patient was brought to the operating room, where after identification of the patient and planned procedure, and general anesthesia was induced and the abdomen prepped and draped in sterile fashion. Small transverse incision was made at the umbilicus, and the Veress needle was placed there and the abdomen insufflated with CO2 until adequate pneumoperitoneum was developed. A 5 mm laparoscope was inserted and the abdominal and pelvic structures were visualized. There is no evidence of significant bowel abnormality, no significant adhesions, no groin hernias noted. The inner aspect of the appendectomy scar is visualized. It is somewhat thin and there is a dome-shaped mild bulge in the abdominal wall resulting in mild asymmetry of the muscle there. There is no true hernia with protrusion of any tissue, but the weakness or bulge that is apparent is consistent in location with his original complaint of asymmetry. There is no evidence of injury or abnormality of the right rectus muscle which is the site of his chronic recurrent pain. Decision was made then to reinforce the inside of the surgical appendectomy scar, so lateral trochars are placed and the peritoneum was incised along the medial aspect of this old scar. The peritoneal flap was developed laterally to expose the underlying muscle. A single sheet of Prolene mesh is trimmed to fit the size of the dissection and introduced into the abdomen, manipulated into place, and stapled securely to the surrounding strong muscle. Peritoneum was then closed over this mesh and representative photographs were taken to document the repair. No other abnormalities being noted, the procedure was terminated and CO2 was allowed to passively escape the trochars are removed. Puncture wounds were closed with layers of fine absorbable suture, and Dermabond dressing is applied. The patient was then awakened from his anesthetic having tolerated the procedure well, and was transferred to recovery room in satisfactory condition.

    I still think it should be 49654 and C1781

    Because he states there is no true hernia I am stuck and don't feel comfortable billing the 49654 Could I have someone elses opinion.
    this is work comp.

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    copied and pasted from a medical dictonary: "a hernia often refers to an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall."

    Sounds like you have a hernia to me. Hernias do not always have to be bulging into other cavities, or have herniated contents within them....although the doctor does say "no true hernia", not sure why.

    If you are still not comfortable using the hernia code, I suggest you go unlisted, doing a comparison to the hernia code.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3


    Thank you very much I will check with doc to see why he says not a true hernia...

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