# 46947  with 46255  or 46945



## codedog (Aug 29, 2011)

Looking at this operative report I tend to want to code 46947 with 46255. Can I do that ?
Booking was 46945 ,which I disagree,any suggestions- thanks 

POSTOPERATIVE DIAGNOSES:	Prolapsed hemorrhoids and external hemorrhoids.

PROCEDURES PERFORMED:	Circular stapled radical hemorrhoidectomy (PPH) and harmonic scalpel excision of internal and external hemorrhoids.

PROCEDURE IN DETAIL:  The patient was taken to the operating room after obtaining informed consent and placed on the operating table in a supine position.  Following the achievement of adequate general endotracheal anesthesia, the patient's legs were placed in stirrups and in a semi-lithotomy Trendelenburg position.

The anal canal was examined and the external hemorrhoids and prolapsing of the internal hemorrhoids was evident.  Digital examination revealed no other mucosal abnormalities other than the hemorrhoids.

The anal canal was dilated and an operating anoscope was introduced inspecting the interior of the anal canal circumferentially.

The patient had a prolapsed hemorrhoid on the right anterior aspect and an additional very large hemorrhoidal complex in the right posterior and right posterolateral aspect of the anal canal.  The left side of the anal canal was reasonably normal.

It was elected to perform a PPH procedure initially to de-vascularize the hemorrhoidal plexus.  This was done in the usual fashion creating an excellent staple line, which was hemostatic.  Following this, excision of the external and internal prolapsed hemorrhoids was accomplished with the harmonic scalpel to the lesions described above.  Hemostasis was complete.  The internal sphincter was left intact.  The specimen was forwarded to pathology and the anal canal was splinted with a roll of Gelfoam.

The patient tolerated the procedure well, was awakened from general anesthesia without complications, and transferred to the recovery room in satisfactory condition.


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## codedog (Aug 30, 2011)

i dont see any bundling


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