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AHA Coding Clinic® for HCPCS - 2022 Issue 4; Ask the Editor

Diastasis recti repair

A patient presents for open repair of a diastasis rectus deformity and recurrent incisional hernia. An elliptical incision was made and extended superiorly to the xiphoid process. The umbilicus was removed and the fascia was entered above the region of the previous umbilical hernia repair. Anterior abdominal wall adhesions and prosthetic mesh from the previous incisional hernia were taken down via cautery. Lysis of adhesions continued as the midline fascial aperture was extended to the xiphoid process. The hernia defect was small, through the attenuated midline fascia and not involving the rectus musculature. The reconstruction was ultimately undertaken via the implantation of a 20 cm x 15 cm mesh prosthetic placed in the retrorectus position.Starting on the right, the posterior rectus sheath was incised longitudinally at its most medial aspect and undertaken to the limits of the skin incision. Using blunt technique, this was undertaken to the level of the linea semilunaris. An identical operative technique was utilized on the left side and once the tissue planes were fully developed, the posterior rectus sheath was closed with a simple continuous suture. The mesh prosthetic was then placed into the retrorectus space with the gripping aspect of the mesh facing anteriorly. The rectus muscles were then retracted medially and placed down on the mesh. The redundant soft tissues inclusive of the fascia involved with the diastasis deformity were then resected with cautery and the linea alba reconstructed by reapproximating the anterior rectus sheath in the midline with a simple continuous suture. The subcutaneous tissues were reapproximated with simple interrupted sutures of 3-0 Vicryl and the skin closed with metal staples.Can you clarify if the diastases recti repair can be reported separately with a hernia repair or is the diastases recti repair inherent to the hernia repair? If reported separately, would CPT code 22999, Unlisted procedure, abdomen, musculoskeletal system, be reported? ...

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