A patient was admitted for repair of a recurrent incisional hernia with incarceration and small bowel obstruction. At surgery, after the hernia was excised, the fascia was assessed. On both sides of the abdomen, the external oblique was released from the internal oblique and the posterior rectus sheath was released from the fascia. The fascia was closed and mesh was placed over the anterior rectus sheath. What is the appropriate root operation for the abdomen component release, and is the placement of the mesh included in the component release?
The abdominal wall is composed of multiple layers (components). In a component separation repair, the layers are separated, so the defect (hernia) can be closed primarily. Since the resulting abdominal wall is now only one layer, it is often reinforced with an additional layer of mesh or other material. If the fascia cannot be closed primarily, then relaxing incisions are made in the abdominal muscle by making additional lateral or posterior incisions to release the muscle. Code the component separation to the root operation “Release.” The appropriate root operation for the placement of the mesh is “Supplement,” since the mesh is being used to reinforce the abdominal wall as well as to prevent recurrence of the hernia. Assign ICD-10-PCS codes as follows:
0KNK0ZZ Release of right abdominal muscle, open approach, for the right component separation
0KNL0ZZ Release of left abdominal muscle, open approach, for the left component separation
0WUF0JZ Supplement abdominal wall with synthetic substitute, open approach for the placement of the mesh