AAPC - Back to school
Results 1 to 3 of 3

Thread: Ventral or Epigastric Herina

  1. #1
    Join Date
    Apr 2007

    Default Ventral or Epigastric Herina

    AAPC: Back to School
    From reading operative report I want to code as follows
    49561--Incarcerated Ventral Herina
    only once, doc office says I should code it as per booking
    49570 x 2 553.29
    I think doc office is wrong
    and my supervisor says code it as 49561 x 2
    I disagree where I only see one incision

    Who is right ?

    PREOPERATIVE DIAGNOSIS: Incarcerated ventral hernia.

    POSTOPERATIVE DIAGNOSIS: Incarcerated ventral hernia x2.

    PROCEDURES PERFORMED: Open repair, reduction and preperitoneal mesh placement to repair two adjacent incarcerated ventral hernias using Ultrapro hernia system mesh prosthesis (oval).

    PROCEDURE IN DETAIL: The patient was taken to the operating after obtaining informed consent and placed on the operating table in a supine position. Following the achievement of adequate general endotracheal anesthesia, the patient’s abdomen previously clipped, was prepped with Betadine Gel and sterilely draped.

    The patient was examined in the holding area prior to anesthesia to confirm presence of an incarcerated mass in the midline epigastric region. A midline incision was made and deepened through the hernia sac, which was separated from the adjacent tissues and a large Mushroom cap hernia sac was separated to the fascia margin, the defect measuring approximately 3 cm in diameter. The contents of the hernia sac were reduced into the abdominal cavity leaving the hernia sac empty and flaccid. The preperitoneal space was developed by incising the fascia margin approximately 1 mm outside the perimeter of the true defect entering the preperitoneal space and fully dissecting the preperitoneal space circumferentially around the defect. On the caudal end of this hernia, an additional unsuspected incarcerated hernia was also identified and was treated in a similar fashion. The hernia defect with a secondary incarcerated ventral hernia measured approximately 2 cm in diameter. Full dissection of the preperitoneal space encircling both defects, which were adjacent to one another by a distance of about 1 cm, was established and then Ultrapro hernia system mesh prosthesis (oval), was introduced through the larger of the two defects and positioned beneath both defects as a single mesh reconstructive procedure. The Onlay mesh was trimmed accordingly and a continuous 2-0 Vicryl plus suture was used to sew the Onlay patch onto the surface of the rectus abdominis muscles circumferentially around the orifice of the two original hernia defects. The subcutaneous tissue was approximated with layers of continuous 3-0 Vicryl suture and the skin was closed with subcuticular 4-0 Vicryl suture and Steri-Strips.
    Last edited by codedog; 11-22-2011 at 01:53 PM.

  2. #2


    I agree with your coding. The only way, I know of, to get reimbursed for multiple hernia is to show separate and distinct repairs. Your Dr is only doing one repair based off "a single mesh reconstructive procedure" in OpNote.

    The RVU's for 2 epi's is 17.82 vs 26.88 for ventral plus the 7.84 for the mesh that can not be added to the epi's. That should be enough to convince them.

    Happy Thanksgiving

  3. #3
    Join Date
    Apr 2007



Similar Threads

  1. Epigastric herina
    By codedog in forum General Surgery
    Replies: 1
    Last Post: 07-10-2012, 11:53 AM
  2. Repair epigastric hernia
    By nabernhardt in forum General Surgery
    Replies: 3
    Last Post: 11-04-2011, 03:42 PM
  3. umbilical herina vs ventral herina
    By codedog in forum Outpatient Facilities
    Replies: 1
    Last Post: 09-12-2011, 07:46 AM
  4. Ventral vs. epigastric hernia repair
    By mrolf in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 03-10-2010, 02:22 PM
  5. Ventral vs Epigastric hernia
    By jaimewicklund in forum General Surgery
    Replies: 0
    Last Post: 06-25-2009, 04:02 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.