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Was a fistulotomy performed? If so, the CPT index for fistulotomy, anal takes you to the range of 46270 to 46280. You'd have to review those codes to make sure which one corresponded to the documentation.
46200 is a fissurectomy. That doesn't match what you've described above.
You wouldn't use 45990 with any of those codes - there's an NCCI edit and a modifier cannot override the edit. The anorectal exam is a component of those surgical procedures and would not be billed separately.
Was a fistulotomy performed? If so, the CPT index for fistulotomy, anal takes you to the range of 46270 to 46280. You'd have to review those codes to make sure which one corresponded to the documentation.
46200 is a fissurectomy. That doesn't match what you've described above.
You wouldn't use 45990 with any of those codes - there's an NCCI edit and a modifier cannot override the edit. The anorectal exam is a component of those surgical procedures and would not be billed separately.