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Recurrent Inguinal Hernia

Check your diagnosis coding for this patient encounter. PREOPERATIVE/POSTOPERATIVE DIAGNOSIS: Recurrent right inguinal hernia. PROCEDURE PERFORMED: Laparoscopic right inguinal herniorrhaphy with mesh. BRIEF HISTORY: This patient is a 66-year-old African American male who presented to Dr. Y’s office with recurrent right inguinal hernia for the second time, requesting hernia repair. History of attempt at open […]

The post Recurrent Inguinal Hernia appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

coding recurrent vs primary wrist ganglion removal

Does anyone have any helpful links or resources that explain when to bill recurrent (25112) vs. primary (25111) wrist ganglion removal? My provider always comes back to me stating that ALL ganglions are recurrent and wants to bill recurrent removal 25112 instead of primary 25111 on every patient, regardless of whether or not the patient has had prior treatment on the ganglion. I would like to have some definitive documentation to back up the correct way to bill/code for a ganglion cyst removal. Thanks!

Medical Billing and Coding Forum

CPT for Reanastomosis of LT recurrent laryngeal nerve

I would appreciate any help regarding the CPT for Reanastomosis of LT recurrent laryngeal nerve as I can not find anything for it.

Doctor performed
1. Left total thyroid lobectomy (60220)
2. Reanastomosis of left recurrent laryngeal nerve (?)
3. Reimplantation of left superior parathyroid gland (60512)

FINDINGS: Left recurrent laryngeal nerve transected, and primary reanastomosis
performed, left superior parathyroid gland devascularized and reimplanted into
the left sternocleidomastoid muscle and marked with Hemoclips, thyroid gland
enlarged, multinodular, hypervascular and inflamed.

…The gland was very hypervascular multinodular and inflamed, very adherent to surrounding structures. The
recurrent laryngeal nerve was found to be coursing over the anterior aspect of the thyroid gland itself and this was transected while dissecting along the thyroid capsule. The 2 ends of the recurrent laryngeal nerve were identified and tagged. A superior
parathyroid gland was identified and its blood supply was preserved, however, during the case, the thyroid was so hypervascular, this was devascularized while obtaining hemostasis. Therefore, the superior parathyroid gland was removed and morcellized and placed back into the sternocleidomastoid muscle on the left at the end of the case. The typical location of the recurrent laryngeal nerve was dissected carefully and there was no nerve of note in this location; however, the distal end of the recurrent laryngeal nerve was found to be entering into the cricothyroid joint and at this point, it was recognized that the abnormal course of the recurrent laryngeal nerve coursing over the anterior aspect of the thyroid lobe was in fact the recurrent laryngeal nerve. The
left thyroid gland was completely removed using Bovie cautery to divide Berry’s ligament and bipolar cautery to divide the isthmus. The left thyroid gland was handed off and the 2 tagged ends of the left recurrent laryngeal nerve were reanastomosed using 9-0 nylon. There was not undue tension on the nerve at this point. There was no identifiable parathyroid tissue on the specimen.

TIA
KM

Medical Billing and Coding Forum

Removal of mesh and repair of recurrent hernia

Does anyone know of documentation that states that the removal of hernia mesh is included in the recurrent hernia repair codes or that 20680 is not to be used for hernia mesh? One of the surgeons I code for found this article on the ACS and wants to bill CPT 20680 for the removal of mesh. See the clinical coding example section of this bulletin.

http://bulletin.facs.org/2017/04/her…/#.WqqYzOjwbIU

Medical Billing and Coding Forum

Recurrent Giloblastoma DSC- MRI

I have a provider that is wanting to do a DSC- MRI for recurrent glioblastoma. I came across this code 76498 -unlisted MRI procedure but I am trying to stay away form this code. Does any one know if this code is correct to use for this MRI service or is there another correct code I can use.

Thank you,
Felicia CPC, CPB, AAPC Professional

Medical Billing and Coding Forum

Coding for Recurrent Lymphoma

:confused: I work for a Hematology/Oncology practice. The patient was said to have Stage IV indolent low grade B-cell lymphoma with associated splenic and bone marrow involvement (due to progressive splenomegaly) and pancytopenia. The doctor marked it as an Extranodal marginal zone B-Cell lymphoma of MALT type and started him on Bendamustine + Rituximab and Peglilgrastim. The patient subequently underwent a splenectomy which pathology showed no evidence of lymphoproliferative disorder or evidence of malignancy. The patient now has a recurrence in the cervical nodes.

I have two questions: First, should this have originally been coded as a NHL (C83.80), MZLS (C83.07) or Extranodal Marginal zone B-Cell Lymphoma, MALT type (C88.4)?

Second, since lymphomas are systemic, hey can be billed as a secondary disease, how should this recurrence be coded for the cervical nodes? Marginal Zone Lymphoma HFN (C83.01) or as one of the code listed above?

Please help! Thank you.

Medical Billing and Coding Forum

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