Hemorrhoidectomy with perianal skin advancement flap


Lathrop, California
Best answers
Hi All,
I am unsure how to code this one.

POSTOPERATIVE DIAGNOSES: Rosette external hemorrhoid, thickened, external, and good size; with accompanying pruritus ani grade 2, and also rosette internal hemorrhoids.

OPERATIVE PROCEDURE: Excisional hemorrhoidectomy in the right posterior quadrant and left posterolateral and excision of the posterior midline with posterior midline perianal skin advancement flap to cover the raw surface area, excisional hemorrhoidectomy in the right anterior quadrant and left anterior quadrant, and anterior midline that incorporated all three of this with some mucosal dissection to approximate it without any tension on closure. There was an isolated intraanal external good size in the right lateral and this was also excised and closed.

So far the best I have been able to come up with is:
46260 for the hemorrhoidectomy
14000 for the advancement flap

However, I am not sure about using 14000 due to this code being designated as and excision and repair of lesion. :confused:
Please help!

Thank you,