Wiki External internal hemorrhoidectomy 3 columns with Island pedicle flap anoplasty Anterior

[carol52]

Hello , I am having a discussion on this one with co -workers and coding manager for the closure.
I came up with three CPT codes for this surgery.
46260 -Removal of INT/ EXT Hem groups.
46288 - Repair of anal fistula ??
15740 - Island pedicle flap graft.
Dr. excised all three columns of the hemorrhoids.
When he excised the rt anterior in the same fashion tying at the anal verge and then continuous running. he then realized that he did not have enough room and needed additional skin to close...
So he marked out a 2x4 anoplasty flap in the house configuration and mobilized it up on the 15 scalper blade onto its vascular pedicle and then advanced into the anal canal. filling the defect and suturing along the base and lateral aspects and closing the donor site defect.
My question is what is codable and is the house flap bundled... I'm being told that the flap and hemorrhoidectomy would bundle under the fistula repair.
Thanks,
Carol

 

[nickelclaw]

Hello,
I don't see where a fistula was done the graft is due to defect from removing hemorrhoids.
46288 does include rectal advancement flap in it's code description but not seeing that this was done.
For the graft I am thinking it is an advancement graft 14040

In Optum 360 coder desk reference the description of 15740 mentions that :the flap involves an anatomically named blood vessel in its creation. Often this tissue is tunneled under the skin and sutured.
Be careful just cause it states vascular pedicle doesn't mean island flap was done. Note after that states advanced.
Just don't feel documentation is there to support 15740. Could query though Hope this helps!