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Ventral or Epigastric Herina

  1. #1
    Default Ventral or Epigastric Herina
    Exam Training Packages
    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 02:53 PM.

  2. Default
    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

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