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Chemodenervation of the internal anal sphincter is a medical procedure aimed at alleviating the symptoms associated with chronic anal fissures. This condition is characterized by painful tears in the lining of the anal canal, which can lead to significant discomfort and complications if not treated effectively. The procedure involves the administration of a denervation agent, such as botulinum toxin, which is injected into the internal anal sphincter muscle. The primary goal of this intervention is to induce relaxation of the sphincter muscle, thereby reducing the tension at the anal opening. This reduction in muscle tension facilitates the healing process of the fissure by allowing for improved blood flow and decreased pain during bowel movements. The physician carefully identifies the location of the fissure and the specific area of the internal anal sphincter that requires treatment. The denervation agent is then injected in divided doses around the targeted area, ensuring that the muscle is effectively treated. The onset of action for the denervation agent is typically rapid, with paralysis of the muscle occurring within a few hours, leading to a significant reduction in symptoms for the patient.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of chemodenervation of the internal anal sphincter is indicated for the treatment of chronic anal fissures. This condition often results in severe pain, bleeding, and discomfort during bowel movements, which can significantly impact a patient's quality of life. The use of this procedure is particularly beneficial for patients who have not responded to conservative treatments, such as dietary modifications, topical medications, or other non-invasive therapies.
The procedure for chemodenervation of the internal anal sphincter involves several key steps that ensure effective treatment of the chronic anal fissure. First, the physician conducts a thorough examination to identify the location of the fissure and assess the condition of the internal anal sphincter. This assessment is crucial for determining the appropriate site for injection. Once the fissure is located, the physician prepares the denervation agent, typically botulinum toxin, ensuring that it is in the correct dosage for injection. The next step involves the careful injection of the denervation agent in divided amounts around the internal anal sphincter area. This technique is designed to maximize the effect of the agent on the muscle while minimizing discomfort for the patient. The injections are performed using a fine needle to ensure precision and reduce the risk of complications. Following the injections, the physician may provide instructions for post-procedure care and monitor the patient for any immediate reactions to the treatment. The denervation agent acts quickly, with paralysis of the internal anal sphincter muscle occurring within a few hours, leading to a reduction in muscle tension and allowing the fissure to heal more effectively.
After the chemodenervation procedure, patients are typically monitored for a short period to observe for any immediate adverse reactions to the denervation agent. It is common for patients to experience some degree of discomfort or mild pain at the injection site, which usually resolves within a few days. Patients may be advised to follow specific post-procedure care instructions, such as avoiding strenuous activities and maintaining a high-fiber diet to facilitate bowel movements. The expected recovery time can vary, but many patients report significant improvement in symptoms within a few days to weeks following the procedure. Regular follow-up appointments may be scheduled to assess the healing of the fissure and the effectiveness of the treatment.
| Short Descr | CHEMODENERVATION ANAL MUSC | Medium Descr | CHEMODENERVATION INTERNAL ANAL SPHINCTER | Long Descr | Chemodenervation of internal anal sphincter | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | 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 | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 96 - Other OR lower GI therapeutic procedures |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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.) | 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.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | 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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| 2011-01-01 | Changed | Guideline information changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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