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Thread: Repair of sliding iguinal hernia , Incarcerated?

  1. #1

    Default Repair of sliding iguinal hernia , Incarcerated?

    AAPC: Back to School

    Can someone help with the following surgery? I am trying to figure out if this should be code 49525 or 49507. There is further instructions in CPT under 49525 to see other codes for Incarcerated. The patient is over 5 years old. Also Should I append a modifier 22 as well due to the time spent? (90 minutes) Thanks in advance!

    A skin incision was made in the left groin. Scarpa
    fascia was divided. Hemostasis was strict and achieved with
    electrocoagulation. Dissection was carried down to the external
    oblique aponeurosis. An incision was made in the external oblique
    aponeurosis lateral to the incarcerated hernia. The external oblique
    aponeurosis was opened and dissected free from the surrounding
    tissues. The large incarcerated left inguinal hernia was dissected
    out of the scrotum. The hernia sac was opened and this contained a
    fairly large amount of bloody fluid along with an incarcerated portion
    of sigmoid colon and also some extraperitoneal adipose tissue as this
    represented a sliding inguinal hernia. The defect involved most of
    the inguinal floor. The defect was gently dilated and the colon was
    reduced without a great deal of difficulty. Some of the
    extraperitoneal adipose tissue was also reduced. The excess hernia
    sac was transected and discarded. The peritoneum was closed around
    and over the hernia using a running suture of 2-0 PDS. The hernia was
    reduced without difficulty. There was a large defect involving the
    inguinal floor. A 4 inch x 6 inch piece of Ultrapro mesh was used for
    the repair. The mesh was secured adjacent to the pubic tubercle using
    0 Prolene and this was carried as a running suture laterally to
    include the shelving portion of the ilioinguinal ligament along with
    the mesh. The repair was carried well lateral to the internal
    inguinal ring. The mesh was split laterally to create a defect for
    the spermatic cord. The upper portion of the mesh was sutured to the
    conjoined tendon and also to the internal oblique aponeurosis
    laterally using interrupted sutures of 0 Prolene. The 2 ends of the
    mesh were brought around the cord. The superior leaflet was sutured
    to the shelving portion of the external oblique aponeurosis using
    interrupted sutures of 0 Prolene to close the internal inguinal ring.
    The repair appeared very secure. The wound was irrigated with normal
    saline. Hemostasis was quite strict considering the amount of
    dissection required. The On-Q PM012 pain pump was also used. The
    trocar was inserted lateral to the skin incision beneath the external
    oblique aponeurosis. The catheter was advanced down the cannula and
    the cannula was peeled away. The tip of the catheter was placed
    adjacent to the pubis. The external oblique aponeurosis was closed
    over the repair using a running suture of 2-0 PDS. The medial portion
    of the external oblique aponeurosis was quite attenuated. Scarpa
    fascia was approximated using running suture of 3-0 PDS. The skin was
    closed using a running subcuticular suture of 4-0 Vicryl. Dermabond,
    sterile dressing, and Tegaderm were applied. Also of note was the
    entire repair from start to finish took 90 minutes.
    This was
    approximately double the amount of time I would have spent on the
    similar repair. The reason for the considerable length of time
    required for the repair was the patient is morbidly obese and weighs
    156 kg. At the completion of the procedure, all sponge, needle, and
    instrument counts were correct. Estimated blood loss was 30 mL. The
    patient tolerated the procedure well and was transported to the PACU
    in stable condition.

  2. #2
    Join Date
    Apr 2007
    Northeast Kansas AAPC


    I would do the 49507 and add modifier 22 since doc clearly states it took twice as long as normal to do the procedure.

  3. #3
    Join Date
    Apr 2007


    I agree with ^lindacoder^. 49507 is more specific to the incarceration and has a little more reporting RVUs


  4. #4

    Default Reply

    Thank you both, that is what i had in mind as well.

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