# anal papilla & hemorrhoid--HELP



## beck627 (Jun 23, 2008)

Hi Everyone~ 
I am a seasoned coder but very new to general surgery coding and I got bit by code 46221 so now I am a little nervous. My MD is stating I should bill 46211 for this surgery which I don't think is right. 

(condensed)  
Anal papilla r posterior quadrant was sharply excised w/scissors and sutured. Anal canal polyp at anterior midline was also sharply excised with scissors and then cauterized. Defect was closed w/3-0 chronic and bites were taken to also ligate an associated internal hemorrhoid. 

I was thinking I should bill 46945 & 46922-51. What do you think? 

All help is greatly appreciated!!!


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## amitjoshi4 (Jun 23, 2008)

beck627 said:


> Hi Everyone~
> I am a seasoned coder but very new to general surgery coding and I got bit by code 46221 so now I am a little nervous. My MD is stating I should bill 46211 for this surgery which I don't think is right.
> 
> (condensed)
> ...


 

Hi, 

The reported coded should be 46922 only. Since there is a single papilla and 46220 covers it which itself is a separate procedure. It will be not reported. 46221 is correct for Ligation of internal hemorrhoid. The documentation says" also ligate an associated internal hemorrhoid".If multiple internal hemorohids were present , then 46945 would have been correct. Look at the cdr of 46221 : "The physician performs hemorrhoidectomy by ligation of an internal hemorrhoid. The physician identifies the internal hemorrhoid. The hemorrhoid is ligated at its base usually with a rubber band. The hemorrhoid tissue is allowed to slough over time." The final codes should be 46922 and 46221.

Thank You


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## beck627 (Jun 24, 2008)

I am so glad I asked! I completely missed the "s" on that code. These hemorroid procedures are deceptively tricky! Thanks for your help!


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