I would say that the lateral polyp and cypt are going to be bundled into teh Fissurectomy/sphincterotomy, but the right posterior polyp sitting on the hemorrhoid is not bundled (seperate site). I would bill 46200 with either 46610, 46611, or 46922. 46610 is removal by hot bx forceps, 46611 is removal by snare, and 46922 is destruction by surgical excision. He does not specify how he excises it (instrument). I would ask.
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