surgery for rectal prolapse

One of my surgeon's has scheduled a Delorme procedure on a patient to repair her rectal prolapse. Any ideas on a CPT code?

surgery for rectal prolapse

http://www.surgeryencyclopedia.com/Pa-St/Rectal-Prolapse-Repair.html

This web site will explain the two common perineal approach to repair a rectal prolapse, one of which is the Delorme. 45505 is what I would code.

Louise

rectal prolapse

The 45505 code is for a proctoplasty for prolapse of mucous membrane. What if its a full thickness prolapse as is frequently the case? I prefer the 45130 code as this says "excision of rectal procidentia." It doesn't necessarily mean proctectomy....If you excise the mucosa as in a Delorme, this is an excision of the procidentia in my opinion. By the way....why can't they just use Delorme and Altemeier as the names...why is it something so obscure like excision of rectal procidentia...Who the hell writes this stuff....doctors don't talk or describe their operations like this.

rectal prolapse

The AMA owns and copyrights CPT codes, so they make up the wording. That doesn't mean it's always physician-friendly, but it is developed by the American Medical Association.

rectal prolapse

Now I know why I'm not a member.

I'm not a member either!

The AMA makes about $30 million a year on licensing fees from the CPT codes! And they threaten to sue anyone that tries to use it without paying- watch out Editor!

re: rectal prolapse is this CPT® 45130 or 45505? Please help!

...I began by making a cursory examination of the external anus. She had large tags in the right lateral position, as well as in the right anterior position. She had significant scarring in the posterior midline just to right and just to the right of midline. It was difficult to really get a good full thickness prolapse because of the amount of scarring that was in the posterior midline. She did have the rectal mucosa which prolapsed out easily, however, her anus and dentate line were quite distorted. They were not in the usual positions. Because of the hemorrhoids and tags in the anterior, it seemed to be protruding out more, but on the left lateral side, headed back to the posterior midline and just to the right of midline, things were significantly scarred and the mucosa did not prolapse out as easily.

We began by assembling a Lone Star retractor and pulling back the tissue as
far as possible. Babcocks were used to prolapse out the tissue and we began by making cautery marks just proximal to the dentate line. Again on the left side in the posterior midline, there was no dentate line. The rectal mucosa appeared to come right out to the anal skin and so we opened up gently and through that area and then about 1 cm proximal to the dentate line and the rest of the anal opening. Because we had such a hard time prolapsing out the tissue from that significant scarring that she had, I elected to perform a Delorme procedure as a repair, as opposed to an Altemeier, and we went down through the mucosal layers and identified the muscularis layer and preserved that, pushed that back. Surprisingly, I was only able to get out a short segment, maybe 4 or 5 cm in the anterior portion and only 2-3 cm in the posterior portion as we tried to prolapse out that tissue and extend the mucosal resection back farther and farther. The rectum itself appeared quite stuck, however, the mucosa was quite redundant and that was about all we could get out. With that then, the mucosa was excised and then we freed up the dentate line and tried to trim up some of the hemorrhoid tissue in order to evert the mucosa out to have a nice repair. With all of the manipulation, her external hemorrhoids were quite swollen and boggy and it became quite an ordeal trying to put the tissue in the correct positions. With that then, we used 2-0 and 3-0 Vicryl suture to create a hand-sewn anastomosis. The mucosa was grabbed with Allis clamps and brought out and then positioned in the correct quadrants, and then our stay sutures were placed at the 4 cardinal points and then interrupted 3-0 Vicryl suture was used to create a hand-sewn
anastomosis. We did use a small pediatric anoscope to ensure that we had
good approximation between the rectal mucosa at the dentate line and bowel
above and I was satisfied that we had a good anastomosis without any gaps.
I then performed a rigid proctoscopy. I was able to pass the scope up to about 15 cm without difficulty. The mucosa appeared otherwise healthy and unremarkable down to our anastomosis. In the external portion of the anus, it appeared quite swollen and inflamed. She had the large tags that were quite boggy, but the anastomosis appeared viable and intact. Gelfoam gauze was then carefully inserted because of the bleeding and oozing that we had had from the procedure, because I think of her Coumadin and Lovenox, and we will hold that for an extra day because of the issues we had. Otherwise I was satisfied with the operation. A sterile dressing was applied over the top. The patient was awakened, extubated, and transported back to the recovery room in stable condition.

surgery for rectal

Sharper-did you get your answer? I think in order for us at this list to give you a code we need more details. 45130 includes anastomosis with perineal approach. This type of procedure is not listed on that web site as a Delorme.
I think we got way off track.
I often take the CPT to the surgeon and show them the code I am thinking best describes the work and then they will either agree or find me a code.
Good Luck
Louise

watch out editor

Yes: absolutely.

Worrying about infringing on the AMA's copyright has been central in our planning!