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  • Posted by 30174, 1 year ago. There are 5 posts. The latest reply is from SuperCoder.
  1. Would you code for an incisional hernia also based on the closure documentation below?

    The peritoneum was closed with running suture of 3-0 Vicryl to the
    umbilicus and then attention directed to repair of the incisional
    hernia. Because of the open bowel operation, no mesh was used in
    this repair. Then the fascia was closed, beginning above the
    incisional hernia which required extending the incision to the
    epigastrium which was the upper limit of the hernia. The fascia
    was closed with interrupted figure-of-eight sutures. Before hernia
    repair could be undertaken, an extensive adhesiolysis had to be
    performed to clear the anterior abdominal wall from bowel attachment.
    This was done with sharp dissection. After the bowel was safely
    out of the way, the fascia was closed with interrupted figure-of-eight
    sutures of #1 Ethibond. These were placed initially without
    securing them until we ensured that we were able to get good closure
    of the entire fascia. Figure-to-eight sutures were then secured
    with good fascial closure and closure of the hernia defect.

  2. Yes I will go for it.An incision is made over the fascial defect. The peritoneal cavity is entered and the sac is dissected free{After the bowel was safely out of the way} from the nearby tissues. The sac is then reduced which is threaded between the muscles and sutured. Finally, the incision is closed with sutures for healing.

  3. The closure itself is from a colectomy.
    Would that make a difference with interpreting
    this properly?

  4. I believe if the hernia was repaired through the same incision made for the colectomy, then you would not bill for it. Here however the surgeon had to extend the incision to epigastrium, so we are in a different location now, and the hernia repair can be coded.

  5. Yes this changes the scenario a bit. The closure comes from colectomy only ,hence incisional hernia repair will be coded separately with a 59 modifier..Code 49560 is a column 2 code for colectomy procedures but a modifier is allowed in order to differentiate between the services provided.The last lines "Figure-to-eight sutures were then secured with good fascial closure and closure of the hernia defect." making me understand the closure of hernia defect also along with the colostomy closure.

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