KBean2018
Guru
Hello would this be code as 46255(Hemorrhoidectomy, internal and external, single column/group) or 46260(Hemorrhoidectomy, internal and external, 2 or more columns/groups)
CPT Code: Procedures:
* HEMORRHOIDECTOMY.
*
ICD-10 : Post-Op Diagnosis Codes:
* Blood in stool [K92.1]
*
Specimens:
ID Type Source Tests Collected by Time
A : Right Posterior Hemorrhoid Tissue Tissue SURGICAL PATHOLOGY TISSUE EXAM
B : LEFT LATERAL HEMORRHOID Tissue Tissue SURGICAL PATHOLOGY TISSUE EXAM
*
*
Findings: An external sentinel tag right anterior anal margin. Grade 2 internal hemorrhoids, evert and meet in the midline. In the right posterior there is a tiny 1-2 mm thrombus plug. The left lateral (posterolateral) hemorrhoid is almost as large and is easily abraded but no active bleeding. The right anterior hemorrhoid is smallest and no surface erosion. With the anoscope in place. There is a submucosal blood blister (tiny hematoma < 1 cm) at the left posterior proximal anal canal with intact mucosa. I leave about 1.5 cm strip of mucosa at posterior midline between the two excised and repaired hemorrhoidectomy sites. I do not remove the small right anterior hemorrhoid.
Indications: with continued bleeding with clots, I offer hemorrhoidectomy should it be the source and at least eliminated if bleeding continues.
*
Description of Procedure: in the supine position with general anesthesia he is placed in padded stirrups and provided IV antibiotic. The perineum is prepped and draped. The rectum is irrigated with dilute betadine and saline. After external inspection, I introduce the slotted anoscope and inspect. Selecting the larger right posterior internal hemorrhoid, I infiltrate 1% lidocaine with epinephrine along the proposed excision line and deep the the cushion for both the right and left posterior hemorrhoids. On the right, I score the mucosa with pinpoint cautery from the proximal canal (just distal to dentate line) to distal just at the mucocutaneous junction. I use cautery in elevating the cushion and excise from distal to proximal. Hemostatic closure is completed with 2-0 chromic running lock suture; I take a proximal purchase of edge and undermine the base and complete distally by taking the distal apex submucosa tied proximally to avoid ectropion. The internal sphincter muscles are not uncovered. The same technique is used on the left hemorrhoid. I irrigate with betadine and saline and clean the surrounding skin. I now inject 10 mL at each site Exparel into the intersphincteric plane to maximize postop pain control. Blood loss is about 20 mL and there was complete hemostasis at conclusion. A rolled lap pad is lathered with gel and introduced as a plug and this is removed once he's placed on the transport bed having been extubated.
CPT Code: Procedures:
* HEMORRHOIDECTOMY.
*
ICD-10 : Post-Op Diagnosis Codes:
* Blood in stool [K92.1]
*
Specimens:
ID Type Source Tests Collected by Time
A : Right Posterior Hemorrhoid Tissue Tissue SURGICAL PATHOLOGY TISSUE EXAM
B : LEFT LATERAL HEMORRHOID Tissue Tissue SURGICAL PATHOLOGY TISSUE EXAM
*
*
Findings: An external sentinel tag right anterior anal margin. Grade 2 internal hemorrhoids, evert and meet in the midline. In the right posterior there is a tiny 1-2 mm thrombus plug. The left lateral (posterolateral) hemorrhoid is almost as large and is easily abraded but no active bleeding. The right anterior hemorrhoid is smallest and no surface erosion. With the anoscope in place. There is a submucosal blood blister (tiny hematoma < 1 cm) at the left posterior proximal anal canal with intact mucosa. I leave about 1.5 cm strip of mucosa at posterior midline between the two excised and repaired hemorrhoidectomy sites. I do not remove the small right anterior hemorrhoid.
Indications: with continued bleeding with clots, I offer hemorrhoidectomy should it be the source and at least eliminated if bleeding continues.
*
Description of Procedure: in the supine position with general anesthesia he is placed in padded stirrups and provided IV antibiotic. The perineum is prepped and draped. The rectum is irrigated with dilute betadine and saline. After external inspection, I introduce the slotted anoscope and inspect. Selecting the larger right posterior internal hemorrhoid, I infiltrate 1% lidocaine with epinephrine along the proposed excision line and deep the the cushion for both the right and left posterior hemorrhoids. On the right, I score the mucosa with pinpoint cautery from the proximal canal (just distal to dentate line) to distal just at the mucocutaneous junction. I use cautery in elevating the cushion and excise from distal to proximal. Hemostatic closure is completed with 2-0 chromic running lock suture; I take a proximal purchase of edge and undermine the base and complete distally by taking the distal apex submucosa tied proximally to avoid ectropion. The internal sphincter muscles are not uncovered. The same technique is used on the left hemorrhoid. I irrigate with betadine and saline and clean the surrounding skin. I now inject 10 mL at each site Exparel into the intersphincteric plane to maximize postop pain control. Blood loss is about 20 mL and there was complete hemostasis at conclusion. A rolled lap pad is lathered with gel and introduced as a plug and this is removed once he's placed on the transport bed having been extubated.