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Billing Codes

CPT codes:

46600Anoscopy, diagnostic
46604Anoscopy with dilation
46606Anoscopy with biopsy, single or multiple
46608Anoscopy with removal of foreign body
46610Anoscopy with polypectomy, hot or bipolar forceps
46611Anoscopy with polypectomy, snare technique
46614Anoscopy with control of bleeding
46615Anoscopy with ablation of tumor(s), polyp(s), or other lesion(s)
46900Destruction, lesions (e.g., condyloma), chemical
46910Destruction, lesions, electrodesiccation
46916Destruction, lesions, cryocautery
46917Destruction, lesions, laser
46922Destruction, lesions, excision

ICD-9 codes:

154.1Cancer, rectum
154.2Cancer, anus
173.5Primary malignant lesion, anus, perianal, or gluteal region
198.2Secondary malignant lesion, anus, perianal, or gluteal region
211.4Benign neoplasm, colon
455.0Int. hemorrhoids
216.5Benign lesion, anus, perianal, or gluteal region
232.5Carcinoma in situ, anus, perianal, or gluteal region
238.2Lesion of uncertain behaviour, anus, perianal, or gluteal region
239.2Unspecified lesion, anus, perianal, or gluteal region
455.1Int. hem., thrombosed
455.2Int. hem., bleeding
455.3Ext. hemorrhoid
455.9Hemorrhoidal skin tags
555.1Crohn's disease: colon
556.9Ulcerative colitis
558.1Radiation colitis
558.9Colitis, nonspecific
564.0Constipation
564.1Irritable colon
565.0Anal fissure
565.1Fistula
566.0Perirectal abscess
Perianal abscess
Ischiorectal abscess
Intersphinteric abscess
569.0Anal polyp
569.3Anal hemorrhage
569.42Anal pain
698.0Pruritus ani
787.6Stool incontinence
787.99Tenesmus
937.0Foreign body, anus

Anoscopy

PRE-PROCEDURE
INDICATIONS
  • Initial evaluation of rectal bleeding, pain, itching, discharge, or masses
  • In association with sigmoidoscopy and colonoscopy (screening or diagnostic)
  • Evaluation of trauma, inflammatory bowel disease (follow-up), and sexual abuse
  • Retrieval of foreign body or treatment of fecal impaction
  • Screening for anal HPV in high-risk individuals (high-resolution anoscopy only)
CONTRAINDICATIONS
  • Unwilling patient
  • Severe debilitation or unstable medical condition
  • Acute abdomen (relative contraindication)
  • Marked anal canal stenosis
EQUIPMENT
  • Anoscope and light source
  • Gloves
  • Lubricant
  • Large-tipped cotton swabs
  • Biopsy forceps, if needed
  • Monsel's solution (ferric subsulfate solution)
  • 3% acetic acid solution (high-resolution anoscopy only)
  • Colposcope with 10 to 40× magnification (high-resolution anoscopy only)
ANATOMY
  • Dentate or pectinate line: The squamocolumnar junction located 2 to 3 cm proximal to the anal verge. No sensory nerve fibers are located above the dentate line—only visceral type.
  • Internal hemorrhoids: Located at and just proximal to the dentate line
  • External hemorrhoids: Located distal to the dentate line at the anal verge

PROCEDURE
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  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE

Thoroughly explain to the patient the findings and any treatment recommendations.
COMPLICATIONS
  • Discomfort from the examination
  • Tearing of the perianal skin, mucosa, or hemorrhoidal tissue
  • Bleeding after biopsy
  • Infection is possible after biopsy but almost never occurs.
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