Results 1 to 2 of 2

Help please!!! Multiple Hernia and small bowel repairs

  1. Default Help please!!! Multiple Hernia and small bowel repairs
    New Call-to-action
    So this case has me in a pickle. Any help is greatly appreciated. The following is the operative report:

    Preoperative Diagnosis: abdominal pain

    Postoperative Diagnoses: Multiple adhesions, internal hernia created by small bowel adhesions.

    Procedures: Diagnostic laparoscopy, lyisis of adhesions, multiple small bowel repairs, closure of internal hernia.

    Summary of Procedure: The patient was taken to the opertaing room, placed supine on the operating table, prepped and draped in the usual sterile fashion. After adequate general endotracheal anesthesia had been obtained, a blunt trip trocar was placed in the right lower quadrant through a previous incision. The abdomen was insufflated to proper pressure. The patient had some murky peritoneal fluid in the abdomen. This was aspirated and cultured. The patient had multiple areas of both small bowel and omentum adherent to the mass. These were carefully taken down. Running the small bowel, no injuries were seen, however, small bowel to small bowel adhesions had caused multiple interloop internal hernias, 2 were taken down, both instances with small bowel serosa, and muscle was injured and was closed with a figure of eight Vicryl suture. The 2 areas that had much larger areas of the small bowel to small bowel adhesions actually just had the mesenteric defects closed with Medtronic clips, as I think taken these down would have caused too much bowel injury that cannot be simply closed and did not appear to be an obstructing type adhesion, however, did run the risk of significant internal hernia. These were closed with Metronic clips. The abdomen was irrigated and aspirated. The anterior abdominal wall was closed with a # 1 Vicryl endo-close.

    Please lead me in the right direction. For the internal hernia I'm thinking unlisted code 49659, for the initial small bowel repair 44202, 44203 for any additional small bowel repairs. Some of my other confusion arises when my doc states that 2 internal hernias were taken down. Does this mean we bill for 2 49659's? Or, is the use of modifier 22 more appropriate. Thank you so much!

  2. #2
    There are no mentions of resections or anastomosis of the small bowls to code 44202 and 44203. All I see a take down of adhesion lap procedure 44180 24 rvu….That includes any enterotomies that was made during the take down of adhesion within the small bowl…as far as the verbiage of internal hernia, I think that is just his/her way of describing it, looped up and all. Hope that shines a new light on things


Similar Threads

  1. Multiple Hernia Repairs
    By krssy70 in forum Gastroenterology
    Replies: 0
    Last Post: 03-18-2014, 08:49 AM
  2. Replies: 0
    Last Post: 08-28-2012, 01:56 PM
  3. Explor Lap, resection of small bowel, hernia repair
    By bill2doc in forum General Surgery
    Replies: 0
    Last Post: 03-19-2012, 12:19 PM
  4. Reduction of hernia and bypass of small-bowel stricture
    By asasands in forum General Surgery
    Replies: 1
    Last Post: 04-20-2011, 12:52 PM
  5. Multiple small bowel resections
    By phoover1955 in forum General Surgery
    Replies: 2
    Last Post: 11-16-2009, 10:16 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.