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47562, 49560, 49585

Kathy k Posted Thu 20th of August, 2015 15:41:01 PM

Patient has had hip disarticulation in 2011, knee surgery in 2005 and appendix surgery in 1973.

Several incisions/transections were made. Could we code this way?

Doctor coded as:
47562
49560-59
49585-59

DX: biliary dyskinesia, umbilical hernia, incarcerated ventral hernia.

Procedure: umbilical herniorrhaphy, ventral herniorrhaphy, laparoscopic cholecystectomy.

Procedure note:

The umbilical hernia was identified. We anesthetized the skin over this and made a vertical incision. Dissection was carried down through subcutaneous tissue with Bovie electrocautery. The umbilical stalk was then isolated off the anterior abdominal wall revealing an approximately 1 1/2 cm umbilical defect. The hernia sac was dissected free from surrounding tissues and transected at the fascial level. We then inserted a 10-mm trocar and secured it with an 0 Vicryl. We inspected the abdomen. There was noted to be a large incarcerated
ventral hernia.

We then turned our attention to the gallbladder. We placed the subxiphoid, right mid axillary and right mid clavicular portion under direct visualization. The gallbladder was identified. Fundus was retracted superolaterally. Hartmann's pouch retracted inferolaterally. We then placed a dissector in there and pulled down the peritoneal
reflections both medially and laterally revealing a small anterolateral cystic artery. This was dissected free and two clips were placed on the patient's side and one clip was placed on the gallbladder side. We transected between second and third with laparoscopic scissors.The cystic duct was then visualized, dissected free, and dealt with in a similar fashion. We then carefully removed the gallbladder from the gallbladder fossa and just past thecystic duct we identified another small posterior artery, where we placed two clips on the patient's side. We continued to move the gallbladder from the gallbladder fossa with the use of Bovie with electrocautery. We then placed it into the endo catch. There was some minimal bleeding from the gallbladder bed so we irrigated this and then cauterized it with Bovie electrocautery. There were no other abnormalities. The gallbladder was placed into an endo catch and then brought out through the umbilical hernia site.

We then extended our midline incision superiorly at approximately 3 cm. We identified the ventral hernia sac, dissected it free from surrounding structures with the use of blunt dissection all the way down to the fascial level where we transected it and passed it off
the field. There was noted to be omentum incarcerated within this. We inspected it and there was an area of omentum that was bleeding and looked a little bit ischemic, so it was transected and the stump was tied with use of 2-0 Vicryl tie. There were no further signs of
bleeding from the rest of the omentum, so this was reduced back into the abdomen. The fascia was grasped superiorly and inferiorly with Kocher clamps and closed with use of an 0 Ethibond in a figure-of-eight times eight. The fascia came together without tension. The
fascia was strong and so we irrigated out with copious amounts of normal saline and did not place a mesh. The umbilical stalk was then tacked down to the anterior wall with use of an O Vicryl in a simple interrupted fashion. The deep tissue was then reapproximated with 3-0
Monocryl and all skin incisions were then closed with skin staples.

SuperCoder Answered Fri 21st of August, 2015 00:34:14 AM

AAE does not provide coding for operative reports and chart notes.
SuperCoder offers SuperCoding on Demand (SOD) (http://www.supercoder.com/coding-answers/coding-on-demand) for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail customerservice@supercoder.com for more information.

Kathy k Posted Fri 21st of August, 2015 11:53:16 AM

Ok well if a patient has had hip disarticulation in 2011, knee surgery in 2005 and appendix surgery in 1973. Then a procedure was recently done for umbilical herniorrhaphy, ventral herniorrhaphy, laparoscopic cholecystectomy through several incisions/transections, Could we code this way?

47562
49560-59
49585-59

DX: biliary dyskinesia, umbilical hernia, incarcerated ventral hernia.

SuperCoder Answered Mon 24th of August, 2015 01:14:19 AM

You cannot bill CPT 49560, if Repair of initial incisional or ventral hernia was done through the same incision by which laparoscopic cholecystectomy and umbilical hernia repair was done. Bill CPT code 47562 and 49585 for laparoscopic cholecystectomy and umbilical hernia repair.

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