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mesh removal not using the add on code

  1. #1
    Question mesh removal not using the add on code
    Medical Coding Books
    Hi Everyone,
    I am trying to code a procedure we performed with another group, we assisted with the main procedure and then also removed mesh but code 11008 has a specific range to refer to ( 10180,11004-11006 ) I was also thinking of maybe using cpt 49402 instead, can anyone give me an insight on this and thank you. I attached the operative note below
    cpt 54530/80
    cpt 49402/59


    DATE OF SERVICE: 11/16/2011


    SURGEON
    MD, FACS


    CO-SURGEO, MD


    ASSISTANT

    UNIVERSITY OF MINNESOTA


    PREOPERATIVE DIAGNOSIS
    Chronic right groin pain and testicular pain.


    POSTOPERATIVE DIAGNOSIS
    Chronic right groin pain and testicular pain.


    PROCEDURE
    1. Explantation of keyhole mesh and plug.
    2. Orchiectomy


    ESTIMATED BLOOD LOSS
    10 cc.


    COMPLICATIONS
    None.


    INDICATIONS
    Mr. ---------- is a 47-year-old gentleman who underwent a right inguinal hernia
    repair approximately 10 years ago. It was done laparoscopically, and he had a
    recurrence. He subsequently had an open repair of that recurrence and
    developed chronic pain that had been very bothersome over the last 7 years or
    so. We tried multiple modalities to help control his pain, and we were never
    really totally successful. We discussed explantation of the mesh, and
    possible orchiectomy. He discussed the situation with Dr. as well.


    We discussed the potential risks, benefits, and alternatives at great length.
    We discussed issues that included, but were not limited to, anesthetic risk,
    hemorrhage requiring transfusion, the risk of transfusion, infection, heart
    attack, stroke, death, recurrence of the hernia, injury to vessels and nerves
    in the region, etc. He had a full understanding of the situation and elected
    to proceed. We should also note that we discussed the possibility that
    explantation and orchiectomy would not cure his chronic pain. Again, he
    elected to proceed.


    OPERATIVE FINDINGS
    The cord was entrapped within the mesh plug. This was removed, as was the
    testicle and cord. There were no complications.


    DESCRIPTION OF PROCEDURE
    The patient was brought to the operating room, placed in supine position,
    prepped and draped in the usual sterile manner. An elliptical incision was
    made around the right groin incision, which was somewhat hypertrophic. The
    subcutaneous tissue was divided using electrocautery. The external oblique
    aponeurosis was identified and incised. We identified the cord structures and
    the underlying mesh. The mesh was grasped at the pubic tubercle and the
    sutures were cut. It was then bluntly dissected with the use of some
    electrocautery away from the underlying musculature. The tails were removed.
    The cremasteric muscles were divided. The inferior epigastric artery was
    identified and preserved throughout the operation.


    With the keyhole mesh removed, the cord structures were well exposed. Dr.
    then performed the orchiectomy, and in doing so we removed the mesh
    plug. Please see his dictation.


    The mesh plug was grasped and retracted. We cut the adhesions of the mesh
    circumferentially as we dissected down to the base of the mesh plug. The cord
    was then clamped and ligated and divided. The mesh was in good position for
    the most part, but inferiorly it had pulled separated from the vessels and
    that is where the recurrence had occurred. This was then sutured down to the
    inguinal ligament to essentially help prevent a recurrence of the hernia.
    Interrupted 0 Nurolon sutures were used. The wound was copiously irrigated.
    The spermatic vessels had been suture ligated. There was no bleeding. The
    external oblique aponeurosis was closed with a running 3-0 Vicryl. We
    injected copious amounts of 0.25% Marcaine. The subcutaneous tissue was
    approximated with a running 3-0 Vicryl. The skin was closed with 4-0 Vicryl
    subcuticular stitch. Steri-Strips were placed. The wounds were dressed. The
    patient was brought to recovery in good condition. There were no
    complications. The patient tolerated the procedure well.






    Dr, , MD, FACS
    Last edited by tgenia; 01-03-2012 at 10:55 AM.

  2. Default
    I'd suggested 20680 - Removal of Implant, Deep. Don't worry about mesh not being an example (eg) in code as the mesh is still considered an Implant. 49402 would be in the cavity, at least that's my interpretation of the code.

    Good Luck!

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Please REMOVE physician / med student names
    A scrubbed note eliminates ALL identifying information ... name/location of hospital/facility, physician names, etc.

    Please remove this information from your posted note to comply with HIPAA.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by gterri View Post
    Hi Everyone,
    I am trying to code a procedure we performed with another group, we assisted with the main procedure and then also removed mesh but code 11008 has a specific range to refer to ( 10180,11004-11006 ) I was also thinking of maybe using cpt 49402 instead, can anyone give me an insight on this and thank you. I attached the operative note below
    cpt 54530/80
    cpt 49402/59


    DATE OF SERVICE: 11/16/2011


    SURGEON
    Dr. JOHNSON, MD, FACS

    CO-SURGEON
    DR, SOVELL, MD


    ASSISTANT
    JOHN DUNBAR, MEDICAL STUDENT
    UNIVERSITY OF MINNESOTA


    PREOPERATIVE DIAGNOSIS
    Chronic right groin pain and testicular pain.


    POSTOPERATIVE DIAGNOSIS
    Chronic right groin pain and testicular pain.


    PROCEDURE
    1. Explantation of keyhole mesh and plug.
    2. Orchiectomy


    ESTIMATED BLOOD LOSS
    10 cc.


    COMPLICATIONS
    None.


    INDICATIONS
    Mr. ---------- is a 47-year-old gentleman who underwent a right inguinal hernia
    repair approximately 10 years ago. It was done laparoscopically, and he had a
    recurrence. He subsequently had an open repair of that recurrence and
    developed chronic pain that had been very bothersome over the last 7 years or
    so. We tried multiple modalities to help control his pain, and we were never
    really totally successful. We discussed explantation of the mesh, and
    possible orchiectomy. He discussed the situation with Dr. Sovell as well.


    We discussed the potential risks, benefits, and alternatives at great length.
    We discussed issues that included, but were not limited to, anesthetic risk,
    hemorrhage requiring transfusion, the risk of transfusion, infection, heart
    attack, stroke, death, recurrence of the hernia, injury to vessels and nerves
    in the region, etc. He had a full understanding of the situation and elected
    to proceed. We should also note that we discussed the possibility that
    explantation and orchiectomy would not cure his chronic pain. Again, he
    elected to proceed.


    OPERATIVE FINDINGS
    The cord was entrapped within the mesh plug. This was removed, as was the
    testicle and cord. There were no complications.


    DESCRIPTION OF PROCEDURE
    The patient was brought to the operating room, placed in supine position,
    prepped and draped in the usual sterile manner. An elliptical incision was
    made around the right groin incision, which was somewhat hypertrophic. The
    subcutaneous tissue was divided using electrocautery. The external oblique
    aponeurosis was identified and incised. We identified the cord structures and
    the underlying mesh. The mesh was grasped at the pubic tubercle and the
    sutures were cut. It was then bluntly dissected with the use of some
    electrocautery away from the underlying musculature. The tails were removed.
    The cremasteric muscles were divided. The inferior epigastric artery was
    identified and preserved throughout the operation.


    With the keyhole mesh removed, the cord structures were well exposed. Dr.
    Sovell then performed the orchiectomy, and in doing so we removed the mesh
    plug. Please see his dictation.


    The mesh plug was grasped and retracted. We cut the adhesions of the mesh
    circumferentially as we dissected down to the base of the mesh plug. The cord
    was then clamped and ligated and divided. The mesh was in good position for
    the most part, but inferiorly it had pulled separated from the vessels and
    that is where the recurrence had occurred. This was then sutured down to the
    inguinal ligament to essentially help prevent a recurrence of the hernia.
    Interrupted 0 Nurolon sutures were used. The wound was copiously irrigated.
    The spermatic vessels had been suture ligated. There was no bleeding. The
    external oblique aponeurosis was closed with a running 3-0 Vicryl. We
    injected copious amounts of 0.25% Marcaine. The subcutaneous tissue was
    approximated with a running 3-0 Vicryl. The skin was closed with 4-0 Vicryl
    subcuticular stitch. Steri-Strips were placed. The wounds were dressed. The
    patient was brought to recovery in good condition. There were no
    complications. The patient tolerated the procedure well.






    Dr, JOHNSON, MD, FACS
    It appears that the 49402 would be correct for the mesh removal. The code 54530 is for Radical Orchiectomy because of a tumor...so I believe the correct code for that procedure is 54520.

    And as is also stated here, when you are redacting an op report you must remove ALL identifying information...so that means all the doctors names and facility names as well.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default
    Quote Originally Posted by ajs View Post
    It appears that the 49402 would be correct for the mesh removal. The code 54530 is for Radical Orchiectomy because of a tumor...so I believe the correct code for that procedure is 54520.

    And as is also stated here, when you are redacting an op report you must remove ALL identifying information...so that means all the doctors names and facility names as well.
    Arelene ... but you included the doctor's names when you quoted the original post ...
    Now that original poster has fixed the original, you might want to edit your quote as well.

    F Tessa Bartels, CPC, CEMC

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