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Thread: Unsure how to code this OP note. Please help!

  1. #1
    Join Date
    Apr 2007
    Lehigh Valley

    Default Unsure how to code this OP note. Please help!

    AAPC: Back to School
    Doc performed an umbilical hernia repair with mesh then used laparoscopy to fix the mesh that had buckled. Do I just use the open code--49585? Below is OP note.

    Curvilinear incision along the superior border of umbilucs was made totaling appx. 2.5 cm. Electrocautery was carried down to the subq tissues. A large hernia sac was appreciated and dissection free from the subq layers of the umbilucus. We isolated the hernia sac down to its stalk at the fascial level and dissected it free with electrocautery. The hernia was then entered, and using manual guidance to protect the abdominal contents from injury, the hernia sac was amputated circumferentially at the base.

    We selected a large Ventralex mesh and placed it into the abd. Both tails were sutured cephalad and caudad in a U stitch fashion. We then closed the fascia over the top of mesh with 3 Ethibond sutures.

    We made a 5 mm incision in the LLQ and placed a 5 mm trocar into this sinus and insufflated the abdomen. Upon inspection, the right lateral portion of the mesh did have buckling so we placed and addtional LUQ 5 mm port under direct visualization. Using the Pro-tracker device, we tacked the mesh in the north, sout, east, and west positions. This maneuver corrected all buckling. Pneumoperitoneum was released.

    Thanks in advance for your help!

  2. #2
    Join Date
    Apr 2007


    I would just bill the open code 49585.

  3. #3


    I would bill the open code but use a modifier 22 to reflect the additional work/time it involved.

  4. #4
    Join Date
    Apr 2007
    Lehigh Valley


    Thanks for responding. I initially thought about the open with 22 modifier, but always seem to doubt myself.

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