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Umbilical Hernia with small periumbilical diastasis closure

Me and co-worker having a discussion in what is best for this scnerrio, we can’t find a code for diastasis closure, not sure if we should use unlisted code or append modifier 22 for provider to get credit. Any thoughts on what is best here… or should closure of diastasis be included in the hernia repair..

49585 -22 or
49585/unlisted code (if so, what amount) OR
49585 by itself

PREOPERATIVE DIAGNOSIS: Pre-Op Diagnosis Codes:
* Ventral hernia with obstruction [K43.6]
POSTOPERATIVE DIAGNOSIS: Post-Op Diagnosis Codes:
* Ventral hernia with obstruction [K43.6]
*
PROCEDURE/SURGERY: Repair of umbilical hernia and small periumbilical diastasis
*
*
ANESTHESIOLOGIST: Anesthesiologist: xxxxxx
ANESTHESIA TYPE: General
*
ESTIMATED BLOOD LOSS: minimal
*
COMPLICATIONS: none
*
FINDINGS: small diastasis andumbilical hernia
*
SPECIMENS: none
*
INDICATIONS FOR SURGERY:bulge and pain
*
SUMMARY OF PROCEDURE:
Patient was placed in the operating table in the supine position. General anesthesia was administered. The abdomen was prepped and draped in the usual fashion. A periumbilical midline incision was made and the hernia was identified. The hernia sac was clearly dissected. The hernia sac was reduced inside and the fascia was closed over with a running ethibond suture. After closure of the fascia, the small diastasis was closed with interrupted ethibond. the subcutaneous tissue was dissected one by four mesh was fashioned and placed over the fascial closure and anchored circumferentially to the fascia with interrupted vicryl. The area was then irrigated with antibiotic solution. . After obtaing hemostasis , the subcutaneous tissue was closed with 3- 0 vucryl and subcuticular monocryl for skin Sterile dressings were applied. Firm pressure dressings placed. Final sponge , needle and instrument count was correct.

PREOPERATIVE DIAGNOSIS: Pre-Op Diagnosis Codes:
* Ventral hernia with obstruction [K43.6]
POSTOPERATIVE DIAGNOSIS: Post-Op Diagnosis Codes:
* Ventral hernia with obstruction [K43.6]
*
PROCEDURE/SURGERY: Repair of umbilical hernia and small periumbilical diastasis

*
ANESTHESIOLOGIST: Anesthesiologist: xxxxxx
ANESTHESIA TYPE: General
*
ESTIMATED BLOOD LOSS: minimal
*
COMPLICATIONS: none
*
FINDINGS: small diastasis andumbilical hernia
*
SPECIMENS: none
*
INDICATIONS FOR SURGERY:bulge and pain
*
SUMMARY OF PROCEDURE:
Patient was placed in the operating table in the supine position. General anesthesia was administered. The abdomen was prepped and draped in the usual fashion. A periumbilical midline incision was made and the hernia was identified. The hernia sac was clearly dissected. The hernia sac was reduced inside and the fascia was closed over with a running ethibond suture. After closure of the fascia, the small diastasis was closed with interrupted ethibond. the subcutaneous tissue was dissected one by four mesh was fashioned and placed over the fascial closure and anchored circumferentially to the fascia with interrupted vicryl. The area was then irrigated with antibiotic solution. . After obtaing hemostasis , the subcutaneous tissue was closed with 3- 0 vucryl and subcuticular monocryl for skin Sterile dressings were applied. Firm pressure dressings placed. Final sponge , needle and instrument count was correct.

Medical Billing and Coding Forum

Help Please!! Dx for umbilical hernia…

I am completely stuck on the diagnosis for this impression by the doctor.

Impression: Umbilical hernia with open draining wound secondary to acute hepatic encephalopathy and cirrhosis with ascites.

I have K72.00 for acute hepatic encephalopathy and K70.31 for cirrhosis with ascites

but I am at a loss for what to use for Umbilical hernia with open draining wound

I would really appreciate any help.

TIA
KAM

Medical Billing and Coding Forum

Chemical cauterization for umbilical granuloma

Since the changes in the CPT 17250 (last update) we have been getting denials from many of the insurance companies. Newborn comes in for first office visit with provider and we us to be able to charge an office visit 992XX with a 25 and the 17250 for chemical cauterization of the umbilical granuloma However since the update they are bundling the 17250 even when we use the modifier 25 with a E/M code. At first I thought that it was because of the update in the icd 10 codes. Since the P83.8 Other specified conditions of integument specific to newborn was what the providers used. However, when I added the 5th digit P83.81 Umbilical granuloma. The insurances are still bundling or denying. My scrubbers don’t come up with any NCCI edits. Any suggestions for getting it paid or resources to go to definitively say it should be bundled?

Medical Billing and Coding Forum

Umbilical Hernia Repair with removal of old mesh and insertion new mesh

I am trying to code an umbilical hernia repair that was done for removal of prior mesh and implantation of new mesh with the hernia repair. The patient had a prior umbilical hernia repair several years ago and now needs the mesh removed due to protrusion from the umbilical skin. Would I code this as an incisional hernia repair with implantation of mesh? I have seen many different opinions of this and need some guidance. I am leaning towards the codes 49560 with 49568.

Thanks for any suggestions.

Valerie K.

Medical Billing and Coding Forum

Assistance with umbilical cord stem cell application for internal med/ortho etc

I was approached by a gentleman that previously had a collection company producing his claims. Here is the situation. He is NOT a provider, yet has an 2 NPI’s. One has the taxonomy of "blood work" yet is not considered a lab. He receives donated umbilical cord blood typically from a C-section. The blood/vein is removed and taken away to the lab where the blood is spun in a machine until only stem cells are left. These stem cells are applied/sprayed I internal or orthopedic cases where the first surgery was not successful. I am trying to find out the codes to bill the patients insurance as a "dme/product vendor" because the owner is not a physician and is not performing the surgery. The frozen stem cells are available for use as the physician deems necessary. The 40+ cases performed, the patients are doing remarkably well.

He had a prior billing company that coded the same codes and are :
38205
38207
38208
38212
38214
38215
38240
All were billed on 4 lines. The 1st line was standard CPT code then the following 3 utilized 59 modifier. He should be able to code for these services as the lab/machine prepared the umbilical cord blood into stem cell and was frozen, preserved, thawed etc. Unfortunately the previous billing company informed him he could utilize the same pre-cert/pre-auth as the hospital! I’m not sure how they stay in business.

Does anyone have any information on this fairly new procedure? Obviously it is allogeneic as it is a different donor aka maternal mother!

The other downfall is the "old school" MD did not state how many CC’s/units utilized however it should state 4 cc’s so that is why I am believing they billed a total of 4 units ??

If someone has experience and can lead me to it, I would GREATLY appreciate it.

Thank you

Medical Billing and Coding Forum

Scope appy w/ umbilical hernia repair

Would like you thoughts on this: Surgean makes umbilical port incision, inserts scope, encounters an incarcerated umbilical hernia. Repairs this without mesh. Proceeds with the laparoscopic appy which is uneventful. CCI edits allows 49653 (hernia repair) and 44970 (appy) in that order.
My quandary is; incision is made in the umbilical area for the scope port, and that incision is repaired on the way out as a matter of procedure, so would these would these two codes be correctly billed together, or is this one of those times that CCI might not provide the best guidance?
Thanks,
Chuck, CPC

Medical Billing and Coding

persistent fetal umbilical vein in pregnancy

How would I code "fetal persistent umbilical vein"? I’m not sure if this is a complication or more of an observation. I’ve tried researching and can’t seem to find an answer (if this is abnormal). Not listed in coding book Index as such.

Pt in third trimester is in for routine OB visit and ultrasound review.

Assessment/Plan:
1. Fetal persistent right umbilical vein — limited fetal echo. Consideration of neonatal echo is recommended.
2. AGA — EFW 22% at 35 weeks.

BTW, a co-worker tells me not to code fetal conditions UNLESS they affect management of mother’s care (e.g., further workup is planned, which is not the case here).

So this is a two-part question: Do I code it, and if yes, what code do I use?

Thank you! I appreciate any suggestions.

Medical Billing and Coding | AAPC Forum