CPT® Code 0377T | Case2Code

Code deleted, see 46999

Official Description

Anoscopy with directed submucosal injection of bulking agent for fecal incontinence

Common Language Description

Anoscopy with directed submucosal injection of a bulking agent for fecal incontinence is a specialized medical procedure aimed at addressing passive fecal incontinence, which is often caused by internal anal dysfunction. This procedure utilizes an anoscope, a tubular instrument designed for visualizing the anal canal and rectum, to facilitate the precise delivery of a bulking agent into the submucosal tissue of the anus. The bulking agent, which may include substances such as hyaluronic acid/dextranomer or Solesta, serves as a space filler that enhances the structural integrity of the anal canal, thereby improving the ability to retain fecal matter. Prior to the injection, an evacuation enema may be administered to clear the rectal area, ensuring optimal conditions for the procedure. The injection process involves making a total of four 1 mL injections strategically placed above the dentate line into the four anal quadrants: posterior, left lateral, anterior, and right lateral. After the injections, the sites are carefully examined for any signs of bleeding before the anoscope is removed, concluding the procedure. This intervention is particularly beneficial for patients who experience involuntary loss of stool, providing a minimally invasive option to enhance anal function and improve quality of life.

1. Indications

The procedure of anoscopy with directed submucosal injection of a bulking agent is indicated for the treatment of passive fecal incontinence, particularly when this condition is attributed to internal anal dysfunction. This may include patients who have difficulty controlling bowel movements due to weakened anal sphincter muscles or other related anatomical issues.

Passive Fecal Incontinence This condition involves the involuntary loss of stool, which can significantly impact a patient's quality of life and may arise from various underlying causes, including internal anal dysfunction.
Internal Anal Dysfunction This refers to the impaired function of the internal anal sphincter, which can lead to difficulties in maintaining fecal continence.

2. Procedure

The procedure begins with the administration of an evacuation enema, which is intended to clear the rectal area and prepare the patient for the injection. Following this, the anoscope is carefully inserted into the anal canal to allow for direct visualization of the treatment area. Once the anoscope is in place, the physician proceeds to perform a total of four injections of the bulking agent, each consisting of 1 mL. These injections are strategically administered slightly above the dentate (pectinate) line, targeting the four anal quadrants: posterior, left lateral, anterior, and right lateral. This precise placement is crucial for maximizing the effectiveness of the bulking agent in enhancing anal tissue volume and function. After completing the injections, the physician checks each injection site for any signs of bleeding to ensure patient safety. Once confirmed that there is no significant bleeding, the anoscope is gently removed, concluding the procedure.

Step 1: Administer an evacuation enema to clear the rectal area.
Step 2: Insert the anoscope into the anal canal for visualization.
Step 3: Perform four 1 mL injections of the bulking agent into the anal quadrants above the dentate line.
Step 4: Check injection sites for bleeding and remove the anoscope.

3. Post-Procedure

After the procedure, patients may be monitored for any immediate complications, such as bleeding or discomfort. It is important for patients to follow any post-procedure care instructions provided by their healthcare provider, which may include recommendations for activity restrictions and pain management. Patients should also be advised to report any unusual symptoms, such as excessive bleeding or severe pain, to their healthcare provider promptly. Recovery time may vary, but many patients can resume normal activities shortly after the procedure, depending on their individual circumstances and the extent of the intervention.

Short Descr	ANOSCPY INJ AGENT FOR INCONT
Medium Descr	ANOSCOPY W/BULKING AGENT INJ FOR FECAL INCONT
Long Descr	Anoscopy with directed submucosal injection of bulking agent 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	09 - 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	Hospital Part B services paid through a comprehensive APC
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	Not applicable/unspecified.