codedog
True Blue
one person says use 46260, I SAY ITS 46947 , but can I also bill for the external hemmorhoid/ ,if so what would you suggest?
POSTOPERATIVE DIAGNOSIS: Symptomatic hemorrhoids.
OPERATION: Hemorrhoidectomy.
BLOOD LOSS: Minimal.
:
4PROCEDURE IN DETAIL:
The patient was brought into the operating room and placed on the operating table in the prone-Jackknife position. The perianal region was prepped and draped in a sterile fashion. The anus was gently dilated up to three fingerbreadths. There was a non-inflamed external hemorrhoid in the patient’s posterior midline. The Hill-Ferguson retractor was inserted into the anus after using 10 cc of 0.25% Marcaine with epinephrine for a perianal block. There were internal hemorrhoids circumferentially which were not inflamed. The PPH stapler was chosen for the procedure and the dilator was inserted into the anus and secured in place to the skin with interrupted 0-silk suture. Next, a pursestring suture of 2-0 Prolene was placed at the 12, 2, 4, 6, 8, 10 and again at the 12 o'clock position. The anvil was placed above it. This was tied down. Manual inspection through the vagina revealed that the mucosa of the vagina was not caught up in the staple line. This was held in place for two minutes. It was fired, held in place for two minutes and then withdrawn. There was an intact donut. The staple line was inspected. It was found to be hemostatic. The anal dilator was removed.
An elliptical incision was made to excise the external hemorrhoid in the posterior midline and this was closed with a running 3-0 chromic suture. The incision was inspected as well as the anus. It was found to be hemostatic. A piece of Gelfoam was placed within the anus.
POSTOPERATIVE DIAGNOSIS: Symptomatic hemorrhoids.
OPERATION: Hemorrhoidectomy.
BLOOD LOSS: Minimal.
:
4PROCEDURE IN DETAIL:
The patient was brought into the operating room and placed on the operating table in the prone-Jackknife position. The perianal region was prepped and draped in a sterile fashion. The anus was gently dilated up to three fingerbreadths. There was a non-inflamed external hemorrhoid in the patient’s posterior midline. The Hill-Ferguson retractor was inserted into the anus after using 10 cc of 0.25% Marcaine with epinephrine for a perianal block. There were internal hemorrhoids circumferentially which were not inflamed. The PPH stapler was chosen for the procedure and the dilator was inserted into the anus and secured in place to the skin with interrupted 0-silk suture. Next, a pursestring suture of 2-0 Prolene was placed at the 12, 2, 4, 6, 8, 10 and again at the 12 o'clock position. The anvil was placed above it. This was tied down. Manual inspection through the vagina revealed that the mucosa of the vagina was not caught up in the staple line. This was held in place for two minutes. It was fired, held in place for two minutes and then withdrawn. There was an intact donut. The staple line was inspected. It was found to be hemostatic. The anal dilator was removed.
An elliptical incision was made to excise the external hemorrhoid in the posterior midline and this was closed with a running 3-0 chromic suture. The incision was inspected as well as the anus. It was found to be hemostatic. A piece of Gelfoam was placed within the anus.
