CPT® Code 0288T | Case2Code

Code deleted, see 46999.

Official Description

Anoscopy, with delivery of thermal energy to the muscle of the anal canal (eg, for fecal incontinence)

Common Language Description

Anoscopy with the delivery of thermal energy to the muscle of the anal canal is a specialized medical procedure primarily aimed at treating fecal incontinence. Fecal incontinence refers to the involuntary leakage of stool from the rectum and anal canal, which can significantly impact a patient's quality of life. During this procedure, thermal energy is applied through a hand-held anoscope, which is a tubular instrument designed for visualizing the anal canal. The patient is typically positioned in a prone-jackknife position to facilitate access to the anal area, and sedation is administered to ensure comfort throughout the procedure. Local anesthetic is also applied to minimize discomfort at the site of intervention. The anoscope is carefully inserted into the anal canal, reaching the dentate line, which is a critical anatomical landmark. Under direct visualization, four titanium needle electrodes are utilized to deliver radiofrequency energy to the targeted tissue for a duration of 90 seconds. This energy application creates thermal lesions in the muscle of the anal canal, which are monitored by thermocouples located at the tips and bases of the electrodes. These thermocouples continuously track the temperature of the treated tissue, ensuring that it does not exceed the preselected target of 185°F (85°C). The procedure involves creating multiple lesions, typically ranging from 16 to 20 applications, in 5 mm increments proximal to the dentate line. The ultimate goal of this intervention is to induce shrinkage and tightening of the anal muscles, thereby alleviating symptoms of incontinence and improving the patient's overall bowel control.

1. Indications

The procedure of anoscopy with the delivery of thermal energy to the muscle of the anal canal is indicated for the following conditions:

Fecal Incontinence - This procedure is primarily performed to address fecal incontinence, which is characterized by the involuntary leakage of stool from the rectum and anal canal.

2. Procedure

The procedure involves several key steps to ensure effective treatment of fecal incontinence:

Step 1: Patient Preparation - The patient is positioned in a prone-jackknife position, which allows optimal access to the anal area. Intravenous (IV) sedation is administered to ensure the patient remains comfortable and relaxed during the procedure. Additionally, a local anesthetic is applied to the anal region to minimize discomfort.
Step 2: Anoscope Insertion - A hand-held anoscope is carefully inserted into the anal canal, advancing to the dentate line under direct visualization. This step is crucial as it allows the physician to accurately target the area requiring treatment.
Step 3: Delivery of Thermal Energy - Four titanium needle electrodes are positioned at the dentate line. These electrodes deliver radiofrequency energy to the tissue for a duration of 90 seconds. The application of thermal energy creates lesions in the muscle of the anal canal, which is essential for the treatment of fecal incontinence.
Step 4: Temperature Monitoring - At the tip and base of each electrode, thermocouples are utilized to continuously monitor the temperature of the treated tissue. The energy delivery is automatically interrupted when the tissue temperature reaches the preselected target of 185°F (85°C), ensuring safety and efficacy.
Step 5: Additional Lesion Creation - Following the initial lesions, additional lesions are created proximal to the dentate line in 5 mm increments. A total of 16 to 20 applications may be performed to achieve the desired therapeutic effect.
Step 6: Inspection and Withdrawal - Once the thermal lesions have been created, the anoscope is withdrawn from the anal canal. The physician inspects the treated region to confirm the correct placement of the lesions and to assess the overall condition of the tissue.

3. Post-Procedure

After the procedure, patients may experience some discomfort or mild pain in the anal region, which is typically managed with standard analgesics. It is important for patients to follow any specific post-procedure care instructions provided by their healthcare provider. Monitoring for any signs of complications, such as excessive bleeding or infection, is also essential. Patients are usually advised to avoid strenuous activities for a short period and to follow up with their physician to assess the effectiveness of the treatment and to discuss any ongoing symptoms or concerns.

Short Descr	ANOSCOPY W/RF DELIVERY
Medium Descr	ANSCPY W/DELVRY THERMAL ENERGY MUSCLE ANAL CANAL
Long Descr	Anoscopy, with delivery of thermal energy to the muscle of the anal canal (eg, for fecal incontinence)
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	9 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Multiple Reduction Applies
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	T2D - Other tests - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	95 - Other non-OR lower GI therapeutic procedures