ksb0211
Guest
This is the first time I've run across this and am unsure what codes would be best to bill. Any assistance would be greatly appreciated.
PREOPERATIVE DIAGNOSIS
Rectal bleeding.
POSTOPERATIVE DIAGNOSIS
1. Extensive hemorrhoids
2. Polyps at splenic flexure, hepatic flexure and at 70 cm adjacent to the hepatic flexure.
OPERATION PERFORMED
1. Flexible sigmoidoscopy with multiple biopsies.
2. Dopplered-driven ligation of internal hemorrhoids with 6 zone ligation and a circumferential mucoplexy at 11 o'clock, 1:00 o'clock and 7:00 o'clock.
DESCRIPTION OF PROCEDURE
The patient was brought to the endoscopy room. Following attainment of sufficient MAC anesthesia, digital examination of rectum was carried out. Scope was moved through the rectal vault and the sigmoid colon. Went through the sigmoid, this patient was scoped a year ago, so we just where we elected to keep going, but certainly he did not need a followup colonoscopy, but as it turned out, the prep was good, so we continued and we made it over to the cecum without difficulty. In the course of doing so, we found three very small polyps, one at the splenic flexure, which we biopsied to exclusion and another at the hepatic flexure, which we biopsied to exclusion and on the way back out. We found another small polyp just distal to the hepatic flexure lesion prior to the transverse colon which also biopsied to exclusion. Once that was done, we brought through the rectal vault and the sigmoid retroflexed was just these enormous amount of hemorrhoids. At this point, we switched the patient over the prone position and using the THD device, we went up and identified with Doppler the hemorrhoid arterial feeders at 11 o'clock, 2 o'clock and at 5:00 o'clock. Here, we carried out a ligation of those hemorrhoids and concurrent mucoplexy to bring the rectal prolapse back within the anal vault then came back at 3:00 o'clock, 7:00 o'clock, and 9 o'clock, and carried out high ligation with minimal mucoplexy, if any at all. At this point, we packed the rectum with a Gelfoam soaked with 2% lidocaine gel and the patient tolerated the procedure well.
PREOPERATIVE DIAGNOSIS
Rectal bleeding.
POSTOPERATIVE DIAGNOSIS
1. Extensive hemorrhoids
2. Polyps at splenic flexure, hepatic flexure and at 70 cm adjacent to the hepatic flexure.
OPERATION PERFORMED
1. Flexible sigmoidoscopy with multiple biopsies.
2. Dopplered-driven ligation of internal hemorrhoids with 6 zone ligation and a circumferential mucoplexy at 11 o'clock, 1:00 o'clock and 7:00 o'clock.
DESCRIPTION OF PROCEDURE
The patient was brought to the endoscopy room. Following attainment of sufficient MAC anesthesia, digital examination of rectum was carried out. Scope was moved through the rectal vault and the sigmoid colon. Went through the sigmoid, this patient was scoped a year ago, so we just where we elected to keep going, but certainly he did not need a followup colonoscopy, but as it turned out, the prep was good, so we continued and we made it over to the cecum without difficulty. In the course of doing so, we found three very small polyps, one at the splenic flexure, which we biopsied to exclusion and another at the hepatic flexure, which we biopsied to exclusion and on the way back out. We found another small polyp just distal to the hepatic flexure lesion prior to the transverse colon which also biopsied to exclusion. Once that was done, we brought through the rectal vault and the sigmoid retroflexed was just these enormous amount of hemorrhoids. At this point, we switched the patient over the prone position and using the THD device, we went up and identified with Doppler the hemorrhoid arterial feeders at 11 o'clock, 2 o'clock and at 5:00 o'clock. Here, we carried out a ligation of those hemorrhoids and concurrent mucoplexy to bring the rectal prolapse back within the anal vault then came back at 3:00 o'clock, 7:00 o'clock, and 9 o'clock, and carried out high ligation with minimal mucoplexy, if any at all. At this point, we packed the rectum with a Gelfoam soaked with 2% lidocaine gel and the patient tolerated the procedure well.