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umbilical herniorrhaphy question

  1. #1
    Default umbilical herniorrhaphy question
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    I have a question on an OP note. I can't tell what to code or what's included. My intern went with an unlisted procedure- 49659 and 44180. I think 44180 is good but it almost looks like an umbilical repair was done, which would be the 49585- I know my surgeon only does initial, reducible hernia repairs- just had a meeting with him and he is going to start documenting better- but what should I do with this one? Are we any where near where we need to be? Also, do these codes 49600-49611 only refer to operating on babies with defects? Kind of a dumb question but still learning about these hernia codes.

    Procedure: Exploratory lap and adhesiolysis and umbilical herniorrhaphy

    "...supraumbilical incision was made and subcutaneous tissue was divided and extended down to the fascial level where a hernia sac was isolated and amputated. The 11 mm trocar was inserted. Pneumoperitoneum was created with carbon dioxide insufflation. A 5mm suprapubic and left lower quadrant port were inserted. Exploration of the abdomen revealed an adhesive band between a proximal area of small bowel mesentery and the right amputated adnexal vascular supply was divied and that appeared to be the point of adhesion formation. Underneath this moderately thick adhesive band was a loop of distal ileum which was tightly compressed and obstructed. The adhesion was clipped with a 5 mm clip on each side and then divided releasing the obstructive point. The small bowel was then run all the way from the ileocecal valve back to the left upper quadrant without any additional adhesions encountered. There were no further obstructive points. The right upper quadrant was examined. The gallbladder was non-inflamed appearing so nothing further was done. A moderate amount of of murky colored peritoneal fluid had been present on entry into the abdomen translocation. The abdomen was irrigated and suctioned. Following this, the umbilical hernia was then repaired after evacuating the pneumoperitonea. O-vicryl figure of eight sutures were placed to repair the fascial defect at the hernia site. Skin was closed..."

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  2. #2
    This looks like it was a laparoscopic procedure so you will need to use laparoscopic hernia repair codes. The code for an umbilical repair is 49652 and I think that the adhesiolysis is included in the repair unless you can prove that the physician took extra time (and I mean a lot of extra time) taking down adhesions. In this case, I would not code the adhesiolysis because it sounds like only one adhesion was in the way of the hernia repair.

    Incisional hernias are the result of a previous surgery or incision made in the patient's abdomen. If the doctor you work for is easy to talk with, ask him to explain the difference between ventral and umbilical hernias; if not, Google is always a GREAT learning tool! Talk with the nurses in the office if you can, learn as much about the procedures as possible. That's what I did when I was coding General Surgery. Ask if they will order the General Surgery coding companion for you; it is a very helpful tool as well. Hope that helps a little!
    Chrissy, CPC

  3. #3
    Jamaica, NY
    Omphalocele is a congenital defect therefore it would be used for infants even though the code is not age specific.

    I agree with Chrissy... would not code 44180 since no mention of extensive lysis of adhesions. Surgeon would have to spend at least an hour +. If documented (not in this case), I would bill the primary procedure code along with modifier 22. In your case, the only billable code is 49652.

  4. #4
    Oh ok! I see the 49652! And that 44180 is included! I talked with my physician and he said he will be better about his documentation. He's real easy to work with so that helps. I just don't understand all of the surgeries so I use Google a ton! And this website! I am trying to order that general surgery book- either ingenix or contexo media? any recommendations?

    Thanks to both of you for all your help!!!

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  5. #5
    I am currently coding Cardiology (which is really difficult for me for some reason!) but I have the Ingenix Cardiology/Cardiothoracic surgery book and it is really helpful. It is my own book but my employer uses Ingenix books as well. I think they are probably all about the same but I've only used Ingenix so I'm sort of biased.
    Chrissy, CPC

  6. #6
    Lol! I'm biased too when it comes to Ingenix bc I fell in love with Encoder- well Optum now but I signed up today for a 20% discount so I can get the book for 169.00! They're expensive but I'll be super stoked when I get it!

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

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