umbilical herniorrhaphy question
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