Transanal Repair of Rectal Prolapse

45130 is the code the Dr's office used, however, a similarly booked case, by the same surgeon, was coded as 45541.

What IS the most appropriate code to use for a transanal approach to repair?


Below is a description from the post-op report for the last case he dictated (listed as transanal repair on surgical schedule).

PREOPERATIVE DIAGNOSIS:
Rectal prolapse.

POSTOPERATIVE DIAGNOSIS:
Rectal prolapse.

PROCEDURE:
Altemeier procedure with anterior levatorplasty.

DESCRIPTION OF PROCEDURE:
In the prone jackknife position, the buttocks were taped, prepped and draped in
the usual fashion. Local was infiltrated as an anal block. A circumferential
injection was made in the rectal wall proximal to the dentate line. Using
electrocautery, a full-thickness incision was made in the rectum 2 cm proximal
to the dentate line. The rectum was completely prolapsed so this was done
externally. The proximal rectal edge was then grasped with Allis clamps and the
rectum was then sequentially dissected free. Posterior mesentery was taken down
with the LigaSure device. Anterior peritoneal reflection was divided which
facilitated removal. Ultimately, 8 inches of the rectum was freed up. At this
point we began to develop some tension. Digital examination up into the pelvis
showed no significant loops left to be removed. Therefore, the dissection was
completed.

The rectum was then transected and full-thickness reinforcing sutures were taken
in the proximal and distal rectal wall at the cardinal points. Utilizing a 4-0
double-arm Maxon, a full-thickness anastomosis was then run circumferentially.
Prior to performing the anastomosis, however, the anterior levators were reefed
to the midline with interrupted 0 PDS sutures. This gave good tightening to the
anal orifice. Once the anastomosis was completed, it was inspected and noted to
be satisfactory. This nicely reduced back up into the anal.

Thanks in advance for you help,