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hernia repair coding, please help?

  1. Default hernia repair coding, please help?
    Medical Coding Books
    I am so confused with these. I don't know whether or not a hernia is considered incarcerated or reducible. I'm getting so many different responses. If the hernia sac is opened and contains fat or omentum but states it's content was reduced, does that mean it's considered incarcerated?

    I also have the following op report, which I'm not sure which CPT code to use

    DX: Recurrent epigastric hernia

    There was a small 2cm recurrent defect in the area of a previous scar with properitoneal fat protruding through it. With patient supine, the midline incision was made just above the umbilicus for about 4cm to 5 cm dissected through the skin and subcutaneous tissue down to the level of the small amount of properitoneal fat protruding through the defect. This was circumfernetially dissected free and then a preperitoneal dissection plane aided circumferentially. A small piece of 2x2 inch polypropylene mesh was selected using #1 prolene sutures. This was was anchored in four quadrants through and through the abdominal wall. With this having been completed, the defect was closed transversely using interrupted O prolene sutures interrupted. The fascia was infiltrated with .25% marcaine as was the skin and subcutaneous tissue.

    I mean , it should be simple, it's the recurrent epigastric repair code 49570, but I was told this is incorrect,

  2. Default Epigastric Hernia Repair
    Per Supercoder Survival Guide on Hernia Repair it states that a reducible hernia can be pushed back through the fascial defect and in contrast the contents of an incarcerated or strangulated hernia are trapped in the hernia sac and cannot be pushed back through the fascial defect.
    I agree with your code 49570 because it does not state in the operative note that the surgeon tried to reduce the peritoneal fat back through the tear in the fascia. Also, the CPT code 49570 states Repair of Epigastric Hernia (eg. Preperitoneal fat); reducible.
    I hope this information helps you...

  3. Default
    Well... now I just realized something.... cpt 49570 is for epigastric hernia repair, but there is no code for "recurrent" epigastric hernia repair... & since op report states it was for recurrent & done thru previous scar ... I'm now thinking Incisional hernia repair code????

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