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Fissurectomy is a surgical procedure aimed at treating anal fissures, which are painful tears in the mucous membrane of the anus. These fissures can result from various factors, including trauma, constipation, or increased pressure in the anal region. The internal and external anal sphincters are critical muscle structures that control the opening and closing of the anus. The internal sphincter operates involuntarily, meaning it is not consciously controlled, while the external sphincter is under voluntary control. When the internal sphincter experiences excessive resting pressure, it may enter a state of spasm, leading to reduced blood flow to the area. This condition can exacerbate the formation of fissures and hinder the healing process of existing ones. The fissurectomy procedure involves making an incision adjacent to the fissure, allowing for the complete excision of the fissure itself. Additionally, if a sphincterotomy is performed, a lateral incision is made in the internal sphincter to relieve muscle tension without fully severing the muscle ring. This surgical intervention aims to alleviate pain, facilitate the passage of stool, and promote healing of the fissures by reducing the pressure and tension in the anal sphincter muscles.
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The fissurectomy procedure is indicated for patients experiencing anal fissures that have not responded to conservative treatments. The following conditions may warrant the performance of this procedure:
The fissurectomy procedure involves several key steps to effectively treat anal fissures. The following outlines the procedural steps:
Post-procedure care is essential for optimal recovery following a fissurectomy. Patients are typically advised to follow specific guidelines to ensure proper healing. This may include recommendations for pain management, such as the use of analgesics, and instructions for maintaining hygiene in the anal area. Patients may also be advised to increase their fluid intake and dietary fiber to facilitate softer bowel movements, reducing strain during defecation. Follow-up appointments are important to monitor healing and address any complications that may arise. Patients should be informed about signs of infection or excessive bleeding and encouraged to report any concerns to their healthcare provider promptly.
| Short Descr | REMOVAL OF ANAL FISSURE | Medium Descr | FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED | Long Descr | Fissurectomy, including sphincterotomy, when performed | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard 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) | 1 - Statutory 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 | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 96 - Other OR lower GI therapeutic procedures |
| 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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