# Transanal hemorrhoidal dearterialization



## lovetocode

Does this procedure (Transanal hemorrhoidal dearterialization) have a CPT code or would I use an unlisted code? 46999?


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## coachlang3

Could you use Hemorrhoid ligation 46945-46946 or hemorrhoidectomy ligation 46221?  I looked and looked and couldn't find an actual code for THD or even HAL (Hemorroid artery ligation).


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## lindacoder

I was told to use 46946 and then depending on the dictation use in addition 45505.  Sorry I can't remember where this info came from.


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## lovetocode

Thank you for your input.  I called the surgeon's office, and they also used 46946.


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## rlcohen76

I just had this exact case last week, we did not use the Hemorrhoidectomy code since the actual hemorrhoid was not removed, only ligation of the vessel. We used an unlisted code. 45999


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## lovetocode

Since the procedure was done with a transanal approach, if you were going to use an unlisted code, why not 46999?  Also, what about 37799 for unlisted vascular procedures?


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## acbarnes

CPT 46945 (single hemorrhoid) or 46946 (2 or more), ligation other than rubber band, is appropriate, plus you should be able to use 76998 for the ultrasound if your MD uses it to locate the artery. 

Do not use 45505 in conjunction. I know they suture up the extra tissue at the time of the procedure, but this really should be bundled since it is part of the procedure almost every time. 45505 is really designed for bigger prolapse repairs, just check out the RVU. If you want to see how the procedure is performed check out this video at: http://www.atlantacolon.com/archives/511 

The video shows the actual procedure towards the end. The work and risk are less than a complex hemorrhoid.


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## sharonvbs

*Code*

Code 0249T


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## colorectal surgeon

Code 0249T is correct.  This is a category III code so has no reimbursement and you'll have to submit documentation requesting what you think is fair reimbursement.  You have to use this code though so the number of these procedures can be tracked and we can get it converted to a category I code.


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## lovetocode

Thanks for the recent input.  We are an anesthesia group, so I don't think I would bill a Cat III code, but it's always good to have the information.


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## LBrager

*0249T code*

Can the 0249T code only be used if you own the equipment?


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