AHA Coding Clinic® for HCPCS - 2025 Issue 1; Ask the Editor

Laparoscopic removal of infected mesh

A patient with a draining abdominal wall sinus and chronically infected mesh from a previous hernia repair, presents for resection of the sinus and laparoscopic removal of the mesh. Initial entry incision was made in the left upper quadrant and under direct visualization, three ports were placed; an 8 mm robotic port, a left lateral abdominal wall port, and a port in the left lower abdomen. These ports allowed access to the peritoneal cavity for examination, and placement of the surgical tools/devices. The robot was docked, and the mesh was visualized. The peritoneum was opened, the abdominal wall was cleared and the mesh, along with inflamed fascia and adjacent inflamed soft tissues were removed. The excised mesh and affected tissues were placed in an endo-catch bag and removed from the abdomen. The fascial defect measuring 10 cm x 3 cm was then closed. To repair the defect, absorbable mesh (20 cm x 10 cm) was cut to size and used to underlay the fascial repair with an overlap. The mesh was placed in the abdomen and sutured into place.Following inspection of the peritoneal cavity and confirmation of adequate hernia repair with the mesh flat against the abdominal wall, the previous infraumbilical scar, the draining sinus, and subcutaneous soft tissue were excised via a 3cm x 1cm elliptical incision. The entire sinus was excised.The patient underwent resection of a draining sinus from the abdominal wall, excision of chronically infected mesh, and an umbilical hernia repair. CPT guidance instructs the use of code 11008 for the removal of infected mesh during a hernia repair. However, the code descriptor does not specify the approach and appears to be intended for an open procedure. What is the appropriate code for the laparoscopic removal of infected mesh? Would an unlisted code be appropriate in this case? ...

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