# Anoscopy



## Jamesarbiso@gmail.com (Apr 29, 2019)

Good morning,

I am new at coding and one of my doctors has coded a High Resolution Anoscopy with Hyfraction and Biopsy as  46607 and 45190 because another physician told him that is what he uses. I think it should be 46007 and 46615. Any help would be appreciated. 

Thank you,

James


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## meghanhannus (Apr 29, 2019)

Hello James,

Is there anyway that you could please add the operative report documentation for this case? CPT 45190 is for the rectal area so I do not think that code is correct.  Hyfrecation in the anal area is a technique used to treat anal dysplasia and condyloma via electric current (electrocautery).


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## Jamesarbiso@gmail.com (Apr 30, 2019)

After discussion of prior cytology/biopsy findings and today’s planned procedure, signed informed consent was given to proceed. The patient was placed in the LLD position. The anal canal was anesthetized with 2% lidocaine gel and an anoscope was inserted. The anal canal and transition zone were stained with a 4x4 gauze sponge soaked in acetic acid (vinegar) inserted through the anoscope as the anoscope was removed. After several minutes, the gauze was removed and the anoscope was reinserted.
360 degrees of the SCJ*was visualized with a colposcope under high resolution with acetic acid staining and Lugol's iodine staining and the following findings were noted:  RP LN lesion with glands, LL and LP AW lesions with CP, LN when Lugol's applied. There was a RL midcanal low-grade appearing area with faint punctations, RA there was a mixed Lugol's, anteriorly and LA were normal.
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Perianally, there were several whitish streaky plaques located posteriorly, RA, LA, almost stellate in appearance.  The LA perianus had the largest PA lesion.
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The 2 intraanal lesions were isolated and anesthetized with 0.5% Marcaine, and a hyfrecator set at 15 watts was used to cauterize the high grade lesions down to the vessels.  Hemostasis was obtained with direct pressure.  Biopsies x 1 was taken perianally after the LA perianal whitish plaque was anesthetized with 0.5% Marcaine  with Baby Tischlers. Bleeding was scant and hemostasis was promoted with pressure to the biopsy site and Monsel's solution.


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## meghanhannus (Apr 30, 2019)

Thank you for posting the op report! 

The documentation reads as if HRA anoscopy was performed (CPT 46601) and then the hyfrecation and perianal lesion biopsy performed not via scope. I recommend double checking by querying your provider to see if they preformed the hyfrecation and perianal lesion biopsy with scope.

*If hyfrecation (electrosurgery)was not performed under scope you can code CPT 46924 and CPT 11104 (baby tischlers is a punch biopsy of the 1 perianal lesion). There are CCI edits w/ 46601 and CPT 46924 and they can't be billed together with any modifier.

*If hyfrecation (electrosurgery) was not performed under scope code CPT 46924 and if HRA w/ biopsy CPT 46607. Okay to bill together as no CCI edits. 

*If both procedures are performed under scope than only bill CPT 46607 as CPT 46615 mentions the lesions not being amenable to removal by biopsy techniques which I do not see mention of that within this op report. There is also a CCI edit with CPT 46607 & CPT 46615 when billed together.


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