Viola Posted Tue 15th of June, 2010 19:30:17 PM
Recurrent hernia with bowel entrapment.
The patient was brought to the operating room and placed in a supine position in the operating table after anesthesia was administered. The entire lower abdomen, penis, and scrotum were prepped and draped in the sterile fashion. A Foley catheter was placed into the bladder, left to drainage during the case and was also left in place after the case. We went through the prior incision that he had in his groin. This was taken down all the way to the level of the inguinal canal. On entry into the inguinal canal, the patient was noted to have a herniating piece of bowel that appeared to be a single loop and extended all the way down into the scrotum. This loop appeared somewhat engorged with blood. The original hernia repair was re-opened. We were able to then decompress the bowel back into the abdomen and the bowel surface noted to be quite friable and had couple of pin- hole size areas of leak. These were over sewed using 3-0 silk. Once bowel had been completely decompressed, it was noted to rapidly appeared well vascularized. At this time, we proceeded to evaluate the floor of the inguinal canal. The entire floor of the inguinal canal was again noted to be weakened with all 5 prior repair having then compromised. It was therefore decided that the hernia should be reconstructed with the use of AlloDerm. Double thick piece of AlloDerm was obtained and appropriately soaked to hydration. It was tailored to form the complete floor of the inguinal canal and then wrapped around the internal ring, and then sewn in place using interrupted sutures of 3-0 Maxon. The wound was copiously irrigated. The cord structures were noted to pass easily into the groin without any evidence of restriction. The cord structures themselves were noted to be within normal limits. At this time, the fascia of the inguinal canal was closed using continuous running suture of 3-0 Vicryl. Subcutaneous tissue was loosely approximated using 4- 0 Vicryl and skin was closed using continuous running subcuticular suture of 5-0 Maxon. Sterile dressing of Steri- Strips and Tegaderm was applied. The patient was noted to be well decompressed at this time. He was transferred to the recovery room in stable condition.
SuperCoder Answered Wed 16th of June, 2010 07:26:32 AM
You cannot report the Alloderm (49568) with an inguinal hernia repair code as they are bundled. Though you have a choice of reporting 17999 for the alloderm, most payers may not cover this. So the best way is to check with your payer reg. 17999.
SuperCoder Answered Wed 16th of June, 2010 07:50:00 AM
This is an recurrent inguinal hernia repair and as per the CPT guidelines just above the code 49491 (starting of the series for "repair of hernia") "With the exception of the incisional hernia repairs (see 49560-49566) the use of mesh or other prostheses is not separately reported." Therefore it does not seem that a separate code for the mesh is required to be used in this case. Only a code for repair of recurrent inguinal hernia (49520 - 49521) should go fine.
SuperCoder Answered Wed 16th of June, 2010 08:10:34 AM