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Hi ,
Surgeon coded 46945-Hemorrhoidectomy, internal, by ligation.
But I think he ligated an external thrombosed hemorrhoid with sutures. I think typically an external hemorrhoid is incised .
I am thinking 46320. Is this correct?
He was placed under heavy sedation and the buttock cheeks were taped apart and we prepped the anal area with Betadine and draped in sterile fashion. I began by providing an anal block using 0.5% bupivacaine mixed with 1% lidocaine. We then inspected the area. His left posterior external hemorrhoid was healing well. There was still some slight induration at the anal verge, but no residual skin opening. I did advance the Hill-Ferguson retractor in paying attention to this left posterior position. There was a band of sphincter spasm evident at the external anal verge as well as deeper down in the area of his discomfort. There was a small fissure associated with this spasm, although it did not penetrate through the mucosa, particularly and certainly there was no exposed muscle fiber. There was a slightly indurated area at the posterior midline, though I could not detect any kind of abscess or leakage from this area. I did probe it somewhat and took a small biopsy of the rectal wall mucosa from here. I did identify
a small-to-moderate size hemorrhoid in this position as well and I did ligate the incoming vessels with a 3-0 PDS figure-of-eight stitch to control this. I did not see any other abnormalities within the anal canal or at the rectal wall. I did dilate the spastic area somewhat using the Pratt bivalve and I then removed the retractors. I taped an ABD pad across the buttocks. The patient was rolled back over on to the Operating Room stretcher and taken back to Same Day Surgery in excellent condition.
Surgeon coded 46945-Hemorrhoidectomy, internal, by ligation.
But I think he ligated an external thrombosed hemorrhoid with sutures. I think typically an external hemorrhoid is incised .
I am thinking 46320. Is this correct?
He was placed under heavy sedation and the buttock cheeks were taped apart and we prepped the anal area with Betadine and draped in sterile fashion. I began by providing an anal block using 0.5% bupivacaine mixed with 1% lidocaine. We then inspected the area. His left posterior external hemorrhoid was healing well. There was still some slight induration at the anal verge, but no residual skin opening. I did advance the Hill-Ferguson retractor in paying attention to this left posterior position. There was a band of sphincter spasm evident at the external anal verge as well as deeper down in the area of his discomfort. There was a small fissure associated with this spasm, although it did not penetrate through the mucosa, particularly and certainly there was no exposed muscle fiber. There was a slightly indurated area at the posterior midline, though I could not detect any kind of abscess or leakage from this area. I did probe it somewhat and took a small biopsy of the rectal wall mucosa from here. I did identify
a small-to-moderate size hemorrhoid in this position as well and I did ligate the incoming vessels with a 3-0 PDS figure-of-eight stitch to control this. I did not see any other abnormalities within the anal canal or at the rectal wall. I did dilate the spastic area somewhat using the Pratt bivalve and I then removed the retractors. I taped an ABD pad across the buttocks. The patient was rolled back over on to the Operating Room stretcher and taken back to Same Day Surgery in excellent condition.
