Umblical Herniorrhaphy or Appendectomy??

Hi there,

Can anyone help me in coding the below operative report, do I need to code only Incarcerated Umblical herniorrhaphy(49587) or Appendectomy(44950), both we can not bill, since 44950 bundled into 49587...

Your help is much appreciated!

Thanks!

OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Incarcerated umbilical hernia with appendix.

PREOPERATIVE DIAGNOSIS: Incarcerated umbilical hernia with appendix.

PROCEDURE:

1. Umbilical herniorrhaphy.

2. Appendectomy.

ANESTHESIA: general endotracheal intubation.

SPECIMENS: Appendix.

IMPLANTS: A 6.2 x 6.3 cm Bard hernia patch.

BLOOD LOSS: Less than 5 mL.

BLOOD REPLACEMENT: None.

POSTOPERATIVE CONDITION: Stable.

INDICATIONS: This pleasant gentleman presents with painful umbilicus. He was

seen to have a incarcerated appendix on the CT scan and was offered surgical treatment.

GROSS DESCRIPTION: The appendix was herniated into the hernia. It was resected and no apparent complications.

DESCRIPTION OF PROCEDURE: After all risks and benefits were explained and discussed with the patient, including not limited to blood loss, infection, as well as injury to intra-abdominal structures. All questions were answered.

Written informed consent was obtained and is in the chart for review. The

patient was given preoperative antibiotics, brought to the operative suite,

placed in a supine position. General endotracheal intubation was performed, respiratory, and pulse oximetry monitoring were obtained and noted to be stable throughout the procedure. The anterior abdominal wall was prepped and draped in usual fashion. Time-out was completed. Local anesthetic was provided to the superior aspect in the umbilicus. Sharp incision created here. An elliptical incision was created on the umbilicus and the umbilicus was excised. There was a large hernia present, it appeared to not want to reduce.

The appendectomy was performed utilizing a GIA stapling device across the base of the appendix and the mesoappendix was taken down, and suture ligation in continuity. The remainder of the cecum fell into the abdomen and the anterior surface of the fascia was cleansed from its subcutaneous fat. A patch was then sewn in all 4 quadrants to the undersurface of the fascia and tied on the anterior surface with 2-0 Prolene. The wings of the patch were then rotated anteriorly and sewn to the anterior fascia. A 0 Biosyn and 0 Prolene were then utilized to approximate the fascial edges and the subcutaneous tissues were then approximated with the dead space utilizing 0 Biosyn. The skin was closed with staples after 2-0 Biosyn closed the superficial subcutaneous layer. Fluffy dressing was applied. The patient tolerated the procedure well. Sponge,needle, and instrument counts were correct.

Umblical Herniorrhaphy or Appendectomy??