# Transrectal hemorrhoidal dearterialization HELP



## lindacoder (Jan 6, 2010)

I'm not sure how to code the following:

With the patient in the dorsolithotomy position, the anus was carefully examined. There are multiple larger internal hemorrhoids. The Dopple ultrasound was then introduced into the anus and starting at about the 5 o'clock position and working counterclockwise the Doppler is utilized to identify the hemorrhoidal arteries. These are identified in six locations. The base of the hemorrhoid is ligated using the suture provided with the device. This was done in figure-of-eight fashion and doubly ligated until the pulse is absent. Next, the suture is run up the hemorrhoid oversewing it to imbricate it to further cut off its arterial venous supply.  This was then tied to itself. This procedure was then repeated six times around the circumference of the anus. At the end of the procedure, there were no audible Doppler pulses found on the anal examination. The patient tolerated the procedure well. Blood loss was minimal. Sponge and instrument counts were correct. 

I was told by the company last year to use 46946 and 45505.  I think the 46946 would work but not the 45505.  Any input is appreciated.


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