General Surgery Coding Alert

Question: The surgeon documents “external excision of rectal lesion with primary closure.” What is the correct CPT code for this procedure — 46220?

Tennessee Subscriber

Answer: No, 46220 (Excision of single external papilla or tag, anus) is not the best code choice, because the surgeon’s note involves the rectum, not anus, and a lesion, not a papilla or tag.

A better choice would be 45171 (Excision of rectal tumor, transanal approach; not including muscularis propria [i.e., partial thickness]).

Documentation support: The surgical note implies a transanal approach based on the fact that the surgeon specifies “external excision.” Similarly, the op note specifies primary closure and doesn’t specify excision into the muscularis propria, both of which indicate a partial thickness excision. Finally, the term “lesion” is non-specific and can refer to a tumor.