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New Left Inguinal Hernia (completed) Recurrent Right Inguinal Hernia (aborted)

Good morning,

Please see below scrubbed highlights from my operative note.
Does the aborted procedure bundle into the completed procedure? I would usually think so but both hernia procedures have distinctly separate CPT codes as well as DX codes.
Any thoughts are appreciated…thanks in advance.

POSTOPERATIVE DIAGNOSES:
1. Left inguinal hernia.
2. Recurrent right inguinal hernia.

PROCEDURE:
1. Laparoscopic left inguinal hernia repair.
2. Attempted right inguinal hernia repair.

LEFT – Sequenced as primary procedure
49560-LT
C1781 [mesh]
K40.90 New Inguinal hernia
D17.6 Cord Lipoma
— was dissected laterally
— dissected out a large cord lipoma [no pathology]
— cleared off the internal ring on the left side.
— placing a left-sided laparoscopic ProGrip mesh

RIGHT -Sequenced as secondary procedure due to reduction of services [NCCI edits]
49651-53-51-RT
K40.91 Recurrent Inguinal Hernia
K91.61 Intraoperative Hemorrhage during digestive procedure
K66.0 Adhesions
Z53.8 Procedure not carried out

— placed our balloon dissector
— the right side was not dissected very well
— peritoneum was densely adherent to the abdominal wall
— there was some bleeding from numerous small vessels
— tried to take down the connective tissue from the right inferior epigastric.
–did incur some bleeding… had to be controlled by ligating the inferior epigastric vein between clips.
–then could not visualize the hernia defect at this point
— Right inguinal hernia repair was aborted

Medical Billing and Coding Forum

Aborted pacemaker placement

Hi, I could use some advice on this please. Would you bill this as a pacemaker placement 33207 with a 53 modifier along with a Venography? I appreciate the info.

PROCEDURE: Venogram was done on the right and left side-patent venous system was confirmed. The patient was prepped and draped in the usual sterile fashion. Access was gained into the left axillary vein after venography and fluoroscopy-first with a micropuncture wire and then with a regular wire. Right sided placement was confirmed after passing the wire below the diaphragm. The prior incision (made at the outside hospital was opened). The two wires were brought out of the incision.
**
The ventricular lead was advanced directly via a 7 Fr long sheath and positioned in the right ventricular mid septum under fluoroscopy. Lead characteristics were measured and were satisfactory. After I split the sheath there was copious bleeding seen. These occurred to have an arterial pulsation and were seen around the lead as well as in an area more lateral and inferior to the lead. I placed several purse-string sutures around the lead and cauterized other areas that appeared to be bleeding. Hemostasis could not be achieved.
*
I finally called the cardiac surgeons, who also placed purse string sutures around the lead with no effect.
*
After a long discussion about possible causes, that included damage to an arterial branch around the vein, or the main axillary artery itself, I decided to pull out the lead. Hemostasis was finally obtained by manual compression with gauze. Using a staged approach, compression was gradually released and hemostasis was confirmed. The wound was closed by the surgeon-please see his note for details.

Medical Billing and Coding Forum

aborted prostatectomy

Hello …..i have this patient who is here for radical prostatectomy (had a prostate cancer) ….. the surgeon did laparotomy …. then the prostate was attached to the rectum and inseparable from it.there was a right inguinal hernia , it was repaired …….the operation aborted due to inability to separate prostate from rectum.

I have three choices here for the code:
1. Radical prostatectomy with modifier 52
2. Radical prostatectomy with modifier 53
3. Exploratory laparotomy.

How do you think I should code this case?

I really do appreciate your help

Linda Barbar

Medical Billing and Coding