hemorrhoid excision/rectal prolapse
Please review. Looks like one procedure to me but surgeon wants to bill 45505 & 46255.NARRATIVE: After general anesthesia was obtained, the patient was placed in the prone position. The left and right buttock were taped and retracted laterally and the perirectal region was then prepped and draped in usual sterile manner. A digital examination was performed. No palpable mass was noted. At the 11 o'clock position, there was noted to be a large area of rectal prolapse with the friable red mucosa extending. At the 9 o'clock position, there was noted to be internal and external hemorrhoid. The apex of the hemorrhoid was grasped with the Allis clamp and a 3-0 chromic suture was placed. The hemorrhoid was then excised in elliptical fashion, en bloc with the excess prolapse rectal mucosa at the 11 o'clock position. They were both taken off the field as specimen. Hemostasis obtained using cautery. The mucosal edges were then reapproximated with a running interlocking 3-0 chromic suture. A second layer of interrupted 3-0 chromic sutures were then placed and no active bleeding was noted. Remaining of the rectum inspected, no significant hemorrhoids were noted. The incision site was infiltrated with 0.5% Marcaine. A sheet of Gelfoam was placed in the rectum and laid across the incision site. A sterile bulky dressing was then placed and the patient was taken to recovery room in stable condition.