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The Thiersch operation, also known as anal encirclement, is a surgical procedure specifically designed to address issues related to rectal incontinence and/or prolapse. This operation involves the strategic placement of a thin band made from non-absorbable materials, such as wire or suture, beneath the skin surrounding the anus. The primary objective of this procedure is to create a supportive fibrous ring that encircles the anus, which serves to reinforce the anal canal and prevent the rectum from prolapsing. By doing so, it effectively reduces the incidence of rectal incontinence, a condition where individuals experience involuntary loss of stool. The Thiersch operation is particularly beneficial for patients who have not found relief through conservative treatments. It is important to note that the CPT® code 46753 is designated for the placement of the wire or suture during this procedure, while the removal of the Thiersch wire or suture is coded under CPT® 46754.
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The Thiersch operation is indicated for patients experiencing rectal incontinence and/or rectal prolapse. These conditions may arise due to various factors, including but not limited to, weakened pelvic support structures, previous surgical interventions, or congenital anomalies. The procedure is typically considered when conservative management strategies have failed to provide adequate relief or improvement in symptoms.
The Thiersch operation is performed through a series of well-defined steps to ensure the effective placement of the encircling band. The procedure begins with the patient being positioned appropriately, typically in a lithotomy position, to allow optimal access to the anal region. Following the administration of anesthesia, the surgeon makes a small incision around the anus to facilitate the placement of the non-absorbable material.
After the Thiersch operation, patients are typically monitored for any immediate complications. Post-procedure care includes managing pain and ensuring proper hygiene around the surgical site. Patients may be advised to avoid strenuous activities and heavy lifting for a specified period to allow for optimal healing. Follow-up appointments are essential to assess the effectiveness of the procedure and to monitor for any potential complications, such as infection or recurrence of symptoms. The removal of the Thiersch wire or suture, if necessary, is performed under CPT® code 46754, and this may occur at a later date depending on the individual patient's recovery and healing process.
| Short Descr | RECONSTRUCTION OF ANUS | Medium Descr | GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE | Long Descr | Graft (Thiersch operation) for rectal incontinence and/or prolapse | 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 |
| 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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