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Transanal hemorrhoidal dearterialization (THD) is a minimally invasive surgical procedure designed to treat symptomatic internal hemorrhoids classified as grade II to IV. Hemorrhoids are essentially natural vascular structures located in the anal canal that can become problematic when the veins within them become varicose, leading to an overflow of arterial blood and subsequent dilation of the hemorrhoidal plexus. The THD technique employs a method known as dearterialization, which involves the suture ligation of the arteries supplying blood to the hemorrhoids, utilizing Doppler ultrasound guidance for precision. This is achieved with the aid of a specialized anoscope and a Doppler transducer, which help identify the hemorrhoidal arteries that branch from the superior rectal artery, typically located 2 to 3 centimeters above the pectinate line. The pectinate line serves as an important anatomical landmark that differentiates between internal and external hemorrhoids based on their position relative to this line. Once the superior rectal arteries are accurately located, they are ligated to reduce blood flow to the hemorrhoidal plexus, thereby alleviating the symptoms associated with hemorrhoids. In cases where there is prolapse of the hemorrhoids, a procedure known as mucopexy may also be performed. This involves lifting the mucosal membrane and suturing it to reposition the hemorrhoidal cushions, ensuring that the final suture placement is at least 5 millimeters above the pectinate line. The THD technique is advantageous as it minimizes postoperative pain and preserves the anatomical integrity of the anal canal, significantly lowering the risk of complications such as incontinence or other functional impairments that can arise from traditional excisional hemorrhoid surgeries.
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The procedure is indicated for the treatment of symptomatic internal hemorrhoids classified as grade II to IV. These grades represent varying degrees of severity, with grade II hemorrhoids being prolapsed but reducible, grade III being prolapsed and requiring manual reduction, and grade IV being irreducible. Patients typically present with symptoms such as bleeding, pain, discomfort, and prolapse during bowel movements.
The transanal hemorrhoidal dearterialization procedure involves several key steps to ensure effective treatment of the hemorrhoids. First, the patient is positioned appropriately to allow for optimal access to the anal canal. A specially designed anoscope is then inserted into the anal canal, which is equipped with a Doppler transducer. This device is crucial for identifying the hemorrhoidal arteries that originate from the superior rectal artery, located approximately 2 to 3 centimeters above the pectinate line. Once the arteries are located using Doppler guidance, the surgeon proceeds to perform suture ligation of these arteries. This step is essential as it reduces the blood flow to the hemorrhoidal plexus, alleviating the symptoms associated with the hemorrhoids. In cases where there is evidence of prolapse, the procedure includes a mucopexy. This involves lifting the mucosal membrane and suturing it to reposition the hemorrhoidal cushions back into their anatomical position. It is important that the final suture is placed at least 5 millimeters above the pectinate line to ensure proper healing and function. Throughout the procedure, care is taken to minimize trauma to the surrounding tissues, which contributes to reduced postoperative pain and a lower risk of complications.
After the transanal hemorrhoidal dearterialization procedure, patients are typically monitored for any immediate complications. Post-procedure care may include pain management and instructions for activity modification to promote healing. Patients are advised to maintain a high-fiber diet and adequate hydration to facilitate bowel movements and prevent straining, which can exacerbate symptoms. Follow-up appointments are essential to assess healing and address any concerns that may arise during the recovery period. Overall, the expected recovery time is generally shorter compared to traditional excisional hemorrhoid surgeries, with many patients experiencing a significant reduction in symptoms and a return to normal activities within a few days.
| Short Descr | INT HRHC TRANAL DARTLZJ 2+ | Medium Descr | INT HRHC TRANSANAL HROID DARTLZJ 2+ W/US GDN | Long Descr | Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, 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 | 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) | none | MUE | 1 |
| 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure |
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| 2020-01-01 | Added | Code added. |
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