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Lap App with Umbilical Hernia Repair?

  1. #1
    Post Lap App with Umbilical Hernia Repair?
    Exam Training Packages
    Any help would be greatly appreciated. 44970 and 49652 with mod 51 on 44970?

    1. Laparoscopic appendectomy.
    2. Repair of umbilical hernias.


    REPLACEMENT: Crystalloid.

    DRAINS: None.


    The patient was then taken to the operating room in the supine position.
    General endotracheal anesthesia was undertaken without difficulty. The
    patient's abdomen was prepped and draped in usual sterile fashion. An 11 blade
    scalpel was used to make an infraumbilical incision. The patient had a large
    ventral hernia and a small umbilical hernia. A Veress needle was placed, and
    low insufflation pressure was converted to high insufflation pressure after
    camera visualization being in the abdomen after a 5 mm trocar was placed. The
    patient was then placed in Trendelenburg, left side down, right side up. Two
    trocars were placed, one suprapubically and one subxiphoid under direct camera
    visualization. The patient was morbidly obese. Omentum was manipulated. The
    appendix was inflamed and grasped with grasping forceps and mesoappendix was
    cauterized with a SonoSurg down to the base of the appendix. Two Endoloops were
    placed at the base of the appendix and incised below the appendix using
    SonoSurg. We cauterized the appendiceal stump. The appendix was delivered to
    the Endobag and then removed from the infraumbilical incision and sent to
    pathology. The right lower quadrant was copiously irrigated with normal saline
    antibiotic solution and trocars and air were removed. The linea alba of the
    infraumbilical hernia was primarily closed with 0-Vicryl figure-of-eight
    fashion. The subcutaneous tissue was closed with 3-0 Vicryl and subcuticular
    5-0 Monocryl. Steri-Strips were applied. Marcaine 0.5% was infiltrated in the
    wounds. The patient tolerated the procedure well and was sent to recovery in
    stable condition. Intraoperative findings, postoperative care and course were
    discussed with the patient's family and questions answered.

  2. #2
    Kansas City, MO
    unfortunately when you do a laparoscopic procedure with a scope through the site of the hernia, the hernia repair is considered inclusive of the closure. You should bill only the lap appe.

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