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Where's the Hemorrhoid ? pATH came back as peranal tissue -Hemorrhoids-
I want to code anal skin tag 46220, and hemorrhoid code 42650 but it says 2 or more columns. What code would you choose?
PREOPERATIVE DIAGNOSIS: External hemorrhoid.
POSTOPERATIVE DIAGNOSIS: External hemorrhoid.
OPERATION: Excision of anal mass, external hemorrhoid.
.
PROCEDURE IN DETAIL:
After appropriate informed consent was signed, the patient was taken to the operating room, intubated, was then placed in a prone position. The area was prepped and draped in normal fashion with DuraPrep solution. A time out was performed to ensure the correct patient for correct procedure. 3-5 minutes were allowed to pass prior to using Bovie cauterization after DuraPrep was used. Digital rectal exam revealed that the patient had a skin tag at the anus on the left hand side around the 11 o'clock position. There was a small pedunculated nevus, which had been bothering the patient. The area was whealed up with 0.25% Marcaine with epinephrine of approximately 3 cc with the anal retractors in. At the apex of this, a 3-0 Chromic suture was placed. Metzenbaum scissors and knife were used to excise this area with the hemorrhoidal complex. This was sent to Pathology for permanent sectioning. Great care was taken not to damage any of the musculature. Excellent hemostasis was noted to be obtained with pressure and one to two touches of Bovie. The mucosa was then reapproximated with 3-0 Vicryl and tied down. Inspection again with anoscopy revealed no evidence of hemorrhage. No other problems. There was no bleeding. Specimen was removed and sent to Pathology for permanent sectioning. A large piece of Gelfoam was placed for postoperative analgesia and for hemostasis. The patient tolerated the procedure and transferred to the recovery room in stable condition.
I want to code anal skin tag 46220, and hemorrhoid code 42650 but it says 2 or more columns. What code would you choose?
PREOPERATIVE DIAGNOSIS: External hemorrhoid.
POSTOPERATIVE DIAGNOSIS: External hemorrhoid.
OPERATION: Excision of anal mass, external hemorrhoid.
.
PROCEDURE IN DETAIL:
After appropriate informed consent was signed, the patient was taken to the operating room, intubated, was then placed in a prone position. The area was prepped and draped in normal fashion with DuraPrep solution. A time out was performed to ensure the correct patient for correct procedure. 3-5 minutes were allowed to pass prior to using Bovie cauterization after DuraPrep was used. Digital rectal exam revealed that the patient had a skin tag at the anus on the left hand side around the 11 o'clock position. There was a small pedunculated nevus, which had been bothering the patient. The area was whealed up with 0.25% Marcaine with epinephrine of approximately 3 cc with the anal retractors in. At the apex of this, a 3-0 Chromic suture was placed. Metzenbaum scissors and knife were used to excise this area with the hemorrhoidal complex. This was sent to Pathology for permanent sectioning. Great care was taken not to damage any of the musculature. Excellent hemostasis was noted to be obtained with pressure and one to two touches of Bovie. The mucosa was then reapproximated with 3-0 Vicryl and tied down. Inspection again with anoscopy revealed no evidence of hemorrhage. No other problems. There was no bleeding. Specimen was removed and sent to Pathology for permanent sectioning. A large piece of Gelfoam was placed for postoperative analgesia and for hemostasis. The patient tolerated the procedure and transferred to the recovery room in stable condition.