Anopexy, Stapling and and fibro epithelial polyp excision CPT codes

Ravikirann

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Dear All,

I have doubt in choosing CPT codes for the below procedure.My doctor coded 46230, 46080 and 46947. As per CCI edits we can not charge 46080 since it is Separate Procedure. But my doubt what code we can choose for Fibro epithelial polyp excision from anal verge (46947). The OT notes as follows;

Patient is in lithotomy position. Patient is under general anaesthesia.
Injection of a dilute solution of adrenaline (1:400,000) to reduce haemorrhage at the site of incision.
A small longitudinal incision made on the lateral side of the anal mucosa.
The free lower edge of the internal sphincter is then grasped, drawn into the wound and its distal portion divided.
The associated sentinel skin tag at the outer end of the fissure, together with the fibroepithelial polyp at the inner end are both excised. The wounds are left open.
After digital examination, and the proctoscopy; a circumferential mucosal purse string suture is placed 3 ½ cm above the dentate line, so that the tightening of this pursestring will draw the mucosa and submucosa into the stapler. The anvil is then introduced into the anus, and the purse string is tightened and knotted around it. A paralytic agent is asked for to be given by the anaesthetist prior to the “critical 3 minutes” when the stapler will be closed. This avoids Valsalva and straining which could lead to bleeding and avulsion. The fenestrated obturator is removed and replaced with
the fully open stapler; HEM stapler (Covidien, Mansfield, MA) .
Then we continue to close the stapler for 60 s. At this point, we release the stapler handle and turn 1 full turn to partially open the anvil. Remove the stapler from the anus. Open the anvil and cut the rectal mucosa to pass it
off the table for pathologic evaluation.
We Replace the fenestrated obturator in the anal canal, and use saline irrigation to assess for hemostasis; we visually inspect the staple line circumferentially until hemostasis is deemed acceptable. Then we Cut the perianal stay sutures and remove all retractors.
The wound is dressed.

Thanks and Regards
Ravi
 
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