AR2728
Expert
I've attached the following operative note and have searched and searched for more information on the above procedures. The physician excised multiple areas o hemorrhoids, they were thrombosed-however, thrombosed hemorrhoids are also "covered" under the 46250 hemorrhoidectomy code. I was leaning towards the 46250 due to the multiple groups excised. I would appreciate any feedback!
Local anesthetic was injected over the skin as well as around the hemorrhoid and a radially oriented elliptical incision was made along the entire length of the hemorrhoids and carried down through the skin to the underlying thrombosed hemorrhoids. Raising superior and inferior flaps, the largest thrombosed hemorrhoid was dissected free bluntly from surrounding skin down to the edges of the largest thrombosed hemorrhoid. This was dissected free circumferentially and was bluntly dissected off of the deeper structures employing careful blunt dissection, dissecting a large thrombosed hemorrhoid free. The hemorrhoid was therefore removed by simply dissecting the vein free and resecting it at the edges of the area of thrombosis with a large thrombosed hemorrhoid about ? dollar size removed. The majority of the swelling was this thrombosed hemorrhoid but the patient had separate thrombosed hemorrhoids just posterior to this at approximately the 7 o'clock position. These hemorrhoids were carefully dissected free from surrounding soft tissues with careful blunt dissection. These were also shelled out and 3 further areas of thrombosed hemorrhoids were resected with the thrombosed portion of the hemorrhoids dissected back to the vein where it wasn't thrombosed and the vein then transected and the thrombosed portion removed. All thrombosed hemorrhoids were removed. Care was taken with only blunt dissection performed to avoid any damage to the underlying
musculofascial structures or sphincteric structures.
April R
Local anesthetic was injected over the skin as well as around the hemorrhoid and a radially oriented elliptical incision was made along the entire length of the hemorrhoids and carried down through the skin to the underlying thrombosed hemorrhoids. Raising superior and inferior flaps, the largest thrombosed hemorrhoid was dissected free bluntly from surrounding skin down to the edges of the largest thrombosed hemorrhoid. This was dissected free circumferentially and was bluntly dissected off of the deeper structures employing careful blunt dissection, dissecting a large thrombosed hemorrhoid free. The hemorrhoid was therefore removed by simply dissecting the vein free and resecting it at the edges of the area of thrombosis with a large thrombosed hemorrhoid about ? dollar size removed. The majority of the swelling was this thrombosed hemorrhoid but the patient had separate thrombosed hemorrhoids just posterior to this at approximately the 7 o'clock position. These hemorrhoids were carefully dissected free from surrounding soft tissues with careful blunt dissection. These were also shelled out and 3 further areas of thrombosed hemorrhoids were resected with the thrombosed portion of the hemorrhoids dissected back to the vein where it wasn't thrombosed and the vein then transected and the thrombosed portion removed. All thrombosed hemorrhoids were removed. Care was taken with only blunt dissection performed to avoid any damage to the underlying
musculofascial structures or sphincteric structures.
April R