Question:
Carmen:
Hi Alicia/Laureen,
How can I determine when is the Hernia Reducible, Incarcerated or Strangulated
The following scenario is one that has created difficulty for me.
The patient was brought to the operating room and placed under general anesthesia, prepped and draped sterilely. An infra-umbilical skin incision was made with a 15 blade and carried down through the subcutaneous tissues using sharp dissection. We carried the dissection down to the fascia and then dissected the umbilicus free from its fascial attachment. We opened the hernia sac, reduced the hernia contents and then repaired the facial defect with interrupted 1-0 Vicril sutures. The ubilicus was tacked back down to the fascia with a single interrupted 3-0 undyed Vicryl. The skin was closed, sponge and needle counts were correct. Patient tolerated the procedure well.
My choice 49585
The correct choice 49587
ANSWER Thread:
Karen Fan:
Hi Carmen,
When I first looked at the scenario I thought the same thing. However when I looked at the difference between the words in the medical dictionary, I found that reducible means restoration to normal position, strangulation is the entrapment of the intestine in a hernia which leads to vascular compromise with ensuing gangrene. Since the contents were reduced instead of just put back into place. This is the difference and why the answer is 49587.
Carmen:
Hi Karen,
Thank you for your help, I am still confused.....Was this a reduced hernia? Because the codes are as follow;
49585- Repair of Umbilical hernia, age 5 years or older; reducible
49587- Repair of Umbilical hernia, age 5 years or older; incarcerated or strangulated.
By reading the scenario my conclusion was reducible hernia (49585) because the cuote "We opened the hernia sac, reduced the hernia contents and them repaired the fascial defect" no word of being incarcerated or strangulated. I think I am missing something.
Thanks again!
Karen Fan:
Hi Carmen,
We opened the hernia sac, reduced the hernia contents and then repaired the facial defect with interrupted 1-0 Vicril sutures. The ubilicus was tacked back down, In the scenario they state that the contents were reduced, what this means is that they removed the contents from the sac then sewed it closed. This is not the same meaning as the code 49585, that code only means to pick up the herniated sac and move it back into place. Since the doctor had to repair the defect that falls into a strangulated hernia code 49587.
Carmen:
You are just amazing, Karen.....I get it now...woowoo....
Thanks, Carmen
Karen Fan:
Hi Carmen,
You don't know how much I needed to hear that. Very glad I could help.
Thanks Karen
Laureen:
Just wanted to add my 2 cents.
Reducible means restoring to normal state. You can reduce a fracture (ever heard of a doctor re-braking a patients nose once it was fractured?) - you can reduce a hernia i.e.. pop it back into place. Then they normally put mesh over the weakened area to prevent it from happening again.
In your report they said they reduced it - good documentation - so it is the 49585 code.
Check out this great website for hernia info http://www.hernianetwork.com/facts.php
Here's another great video:
Luna:
This is all very interesting.
I'm not a coder by any means yet. However, looking at the info presented by both Karen and Laureen I have a few thoughts myself. (I can see this is going to be a very challenging career. Good thing I like challenges and love to review and extract data.)
Anyway, looking at the Website provided by Laureen ( http://www.hernianetwork.com/facts.php ) and the description of the procedures given in Carmen's example I do believe that code 49587 is correct.
Why: The procedure involved more than just reducing (putting back) the hernia. The procedure involved reducing the "hernia contents". This indicates that the hernia was strangulated or contained gangrene and necrotic bowel.
Not sure Carmen if this was a test/quiz/workbook question, but I bet the wording was carefully chosen so as to make you think a little deeper about what all the procedure involved. Just putting the hernia back "reduces" the hernia, yes. However, it also involved reducing the "hernia contents" which I think would be code 49587.
I will admit that I am only......80% confident because I have no coding experience at all! I have yet to see a manual. I will be starting my MTA/PBC courses next week and am very excited about it.
Laureen:
I think part of the problem here is understanding when they say "reducible" in the code description they mean manually or without need of surgery. Then in the op report they use terms like "reduce" and that makes us think "oh it's a reducible" hernia which it does not. I feel for this myself.
Here is another source defining this:
Reducible vs Nonreducible Hernias
A hernia with a bulge can be classified based on whether or not the bulge can be flattened.
And from CPC Assistant:
So you can surgically reduce a hernia (i.e.. put the contents back where they belong) but that doesn't mean it was diagnostically considered a reducible hernia (i.e.. able to with your hands push the contents back into place).
Soooooo we have to look for language that indicates if the contents of the hernia were stuck somehow (incarcerated). This blip is very vague. When I'm reading it I'm not getting the sense anything was trapped. But I don't code these everyday. I'd like to see a "Indications" section of the report to decide. Where did this blurb come from? A practice exam?
We need to find an experienced hernia coder for this one to be absolutely sure.
joannesheehan:
The argument is whether it is reducible or incarcerated or strangulated....
Key word is reduced.
Incision was made and hernia was reduced. Notes did not indicate any type of strangulation or incarceration. I would code 49585.
I came to that conclusion after reading procedure- I double checked with my husband who is also a CPC and a doctor. He said it was 49585 as well.
I would be interested to see how the correct answer is supposed to be 49587?
Jo-Anne Sheehan, CPC, CPC-I
Carmen:
Hi Alicia/Laureen,
How can I determine when is the Hernia Reducible, Incarcerated or Strangulated
The following scenario is one that has created difficulty for me.
The patient was brought to the operating room and placed under general anesthesia, prepped and draped sterilely. An infra-umbilical skin incision was made with a 15 blade and carried down through the subcutaneous tissues using sharp dissection. We carried the dissection down to the fascia and then dissected the umbilicus free from its fascial attachment. We opened the hernia sac, reduced the hernia contents and then repaired the facial defect with interrupted 1-0 Vicril sutures. The ubilicus was tacked back down to the fascia with a single interrupted 3-0 undyed Vicryl. The skin was closed, sponge and needle counts were correct. Patient tolerated the procedure well.
My choice 49585
The correct choice 49587
ANSWER Thread:
Karen Fan:
Hi Carmen,
When I first looked at the scenario I thought the same thing. However when I looked at the difference between the words in the medical dictionary, I found that reducible means restoration to normal position, strangulation is the entrapment of the intestine in a hernia which leads to vascular compromise with ensuing gangrene. Since the contents were reduced instead of just put back into place. This is the difference and why the answer is 49587.
Carmen:
Hi Karen,
Thank you for your help, I am still confused.....Was this a reduced hernia? Because the codes are as follow;
49585- Repair of Umbilical hernia, age 5 years or older; reducible
49587- Repair of Umbilical hernia, age 5 years or older; incarcerated or strangulated.
By reading the scenario my conclusion was reducible hernia (49585) because the cuote "We opened the hernia sac, reduced the hernia contents and them repaired the fascial defect" no word of being incarcerated or strangulated. I think I am missing something.
Thanks again!
Karen Fan:
Hi Carmen,
We opened the hernia sac, reduced the hernia contents and then repaired the facial defect with interrupted 1-0 Vicril sutures. The ubilicus was tacked back down, In the scenario they state that the contents were reduced, what this means is that they removed the contents from the sac then sewed it closed. This is not the same meaning as the code 49585, that code only means to pick up the herniated sac and move it back into place. Since the doctor had to repair the defect that falls into a strangulated hernia code 49587.
Carmen:
You are just amazing, Karen.....I get it now...woowoo....
Thanks, Carmen
Karen Fan:
Hi Carmen,
You don't know how much I needed to hear that. Very glad I could help.
Thanks Karen
Laureen:
Just wanted to add my 2 cents.
Reducible means restoring to normal state. You can reduce a fracture (ever heard of a doctor re-braking a patients nose once it was fractured?) - you can reduce a hernia i.e.. pop it back into place. Then they normally put mesh over the weakened area to prevent it from happening again.
In your report they said they reduced it - good documentation - so it is the 49585 code.
Check out this great website for hernia info http://www.hernianetwork.com/facts.php
Here's another great video:
Luna:
This is all very interesting.
I'm not a coder by any means yet. However, looking at the info presented by both Karen and Laureen I have a few thoughts myself. (I can see this is going to be a very challenging career. Good thing I like challenges and love to review and extract data.)
Anyway, looking at the Website provided by Laureen ( http://www.hernianetwork.com/facts.php ) and the description of the procedures given in Carmen's example I do believe that code 49587 is correct.
Why: The procedure involved more than just reducing (putting back) the hernia. The procedure involved reducing the "hernia contents". This indicates that the hernia was strangulated or contained gangrene and necrotic bowel.
Not sure Carmen if this was a test/quiz/workbook question, but I bet the wording was carefully chosen so as to make you think a little deeper about what all the procedure involved. Just putting the hernia back "reduces" the hernia, yes. However, it also involved reducing the "hernia contents" which I think would be code 49587.
I will admit that I am only......80% confident because I have no coding experience at all! I have yet to see a manual. I will be starting my MTA/PBC courses next week and am very excited about it.
Laureen:
I think part of the problem here is understanding when they say "reducible" in the code description they mean manually or without need of surgery. Then in the op report they use terms like "reduce" and that makes us think "oh it's a reducible" hernia which it does not. I feel for this myself.
Here is another source defining this:
Reducible vs Nonreducible Hernias
A hernia with a bulge can be classified based on whether or not the bulge can be flattened.
- A reducible hernia is a hernia with a bulge that flattens out when you lie down or push against it gently. This type of hernia is not an immediate danger to a person’s health, although it may be painful and worsen over time if left untreated.
- A nonreducible hernia occurs when the loop of the intestine becomes trapped and a person loses the ability to make the bulge flatten out. Nonreducible hernias are often very painful and require prompt medical attention.
And from CPC Assistant:
Reducible Hernias
A reducible hernia is one that can be corrected by manipulation; there is free mobility of the hernia contents through the hernial orifice.
Incarcerated Hernias
In medicine, incarcerated means the abnormal imprisonment of a part (ie, a hernia that is nonreducible). A nonreducible hernia is one that cannot be reduced by manipulation. In these types of hernias, the hernial contents are fixed in the hernial sac. The reasons these hernias have become nonreducible include incarceration, adhesion formation, and size of the hernia.
Strangulation is the most serious complication related to a hernia. Congestion or strangulation at the hernial ring impairs the blood supply to the herniated part. Once the vessels are obstructed, a simple incarceration becomes a strangulation. Because of its compromised blood supply, strangulated hernias are a surgical emergency. If the condition is allowed to go untreated, necrosis of the strangulated part occurs, leading to peritonitis.
So you can surgically reduce a hernia (i.e.. put the contents back where they belong) but that doesn't mean it was diagnostically considered a reducible hernia (i.e.. able to with your hands push the contents back into place).
Soooooo we have to look for language that indicates if the contents of the hernia were stuck somehow (incarcerated). This blip is very vague. When I'm reading it I'm not getting the sense anything was trapped. But I don't code these everyday. I'd like to see a "Indications" section of the report to decide. Where did this blurb come from? A practice exam?
We need to find an experienced hernia coder for this one to be absolutely sure.
Karen - is this based on some guidelines we could look at? I've been scouring the 'net for hours on this one and it has me a bit unsure. I read "repaired the facial defect" and that doesn't translate to incarcerated contents to me. Just trying to work this out to a definitive conclusion or else it is going to keep bugging me ;-)Since the doctor had to repair the defect that falls into a strangulated hernia code 49587.
joannesheehan:
The argument is whether it is reducible or incarcerated or strangulated....
Key word is reduced.
Incision was made and hernia was reduced. Notes did not indicate any type of strangulation or incarceration. I would code 49585.
I came to that conclusion after reading procedure- I double checked with my husband who is also a CPC and a doctor. He said it was 49585 as well.
I would be interested to see how the correct answer is supposed to be 49587?
Jo-Anne Sheehan, CPC, CPC-I