Difference between 46255 and 46260 -columns

codedog

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What is the difference between the columns when performing an hemorrhoidectomy ?
Is it when doc states two hemorrhoids one at 12 o'clock position and say ONE AT 3 o'clock position ?, does thisc mean 2 columns ? little confused on this. here is an example . does

PREOPERATIVE DIAGNOSIS: Hemorrhoids.

POSTOPERATIVE DIAGNOSIS: Hemorrhoids.

PROCEDURE PERFORMED: Hemorrhoidectomy.

ANESTHESIA: General endotracheal anesthesia.

ESTIMATED BLOOD LOSS: Minimal.

SPECIMEN: Hemorrhoidal tissue to pathology.

COMPLICATIONS: None.

INDICATIONS: Acomplaints of bleeding per rectum especially after bowel movements and also complains of fissure and hemorrhoids s.

BRIEF OPERATIVE NOTE: The risks of the surgery including bleeding, infection, scar, damage to the nearby structures including vessels, nerves, sphincter, incontinence of gas or stools, need for additional surgery, thrombosis and embolism were explained to the patient in detail, who understood the procedure well and gave us his permission.

After informed consent was obtained, the patient was taken to the operating room and placed supine on the operating table. SDCs were placed. After general anesthesia care was established, then the patient was placed in a left lateral position and the perianal area was prepped and draped in standard surgical fashion. 1% lidocaine with epinephrine was used to provide for an anal block. The retractor was then introduced. The patient had two large hemorrhoids at 12 o’ clock and 3 o’ clock position. Starting with the hemorrhoids at the 12 o’ clock position, the hemorrhoid was held with an Allis clamp. Following this, the lidocaine with epinephrine was injected at the base and then an elliptical incision was made and the hemorrhoidal tissue was then resected and passed off the field. A 2-0 chromic stitch was placed to re-approximate the mucosa. A vent was left open at the skin level. Following this, in a similar fashion, 0.5% lidocaine with epinephrine was applied at the base of the hemorrhoidal tissue at the 3 o’ clock position and was held with an Allis clamp. 3-0 chromic stitch was applied. Following this, the hemorrhoidal tissue was resected and was passed off the filed. _____ (03:42) was re-approximated using locked running stitches. A vent was left open at the skin levels. Following this, the area was irrigated. There was no oozing present. A lidocaine soaked Gelfoam was then pulled up and was placed into the anal cavity. Following this, a sterile dressing was applied.
 

bethh05

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ASCExpert states to report 46260 for complex or extensive removal, often by dissecting surgery of both internal and external hemorrhoids. Hope this helps!
 
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