Wiki 46255 ?59

[codedog]

Hello , I need someone advice on this procedure , Should I code 46255 with a 59 since it was just internal , not sure on scar biopsy since he states full thickness ? Any suggestions is appreciated Postoperative diagnosis: prolapsing hemorrhoids and scar noted just proximal to left anterior lateral internal hemorrhoid Procedure: Excision of left anterior lateral internal hemorrhoid and scar from biopsy Anesthesia monitored anesthesia care Indication: 1 cm adenomatous lesion in the anal canal just proximal to the hemorrhoids. This was excised and confirmed to be tubular adenoma with high-grade dysplasia. As such she was recommended to have a full-thickness excision to ensure negative margins. Description of procedure: Following signing informed consent is taken the operating room placed supine position. Monitored I anesthesia was administered he was placed in prone jack-knife position with buttocks taped apart. I then injected local 0.25% Marcaine with epi circumferentially around the anal canal performing an anal block. Digital rectal exam was performed no palpable masses are seen. Patient does have a prolapsing internal hemorrhoid in the right posterior position and also in the left anterior lateral position. Anoscopy is then performed demonstrating large hemorrhoids. Scarring is noted just proximal to the left anterolateral hemorrhoid. Decision was made to excise the internal hemorrhoid in this column and excise the scar tissue from the biopsy. This is excised full thickness without event. Defect is closed with 3 0 Vicryl. Gelfoam was placed into the anal cana