# Exc Rectal Tumor, Hemorrhoid on Path



## acbarnes (May 24, 2011)

The physician dictated a partial transanal excision of rectal tumor for unspecified tumor and a Ligation of an internal hemorrhoid on the op report. the path for the transanal excision came back as a hemorrhoid. 

My dilemma is that I was taught to bill with path,; however, the ACS coding person states I should code 239.0 and not use the path report until the first visit post op. She stated that I should always code at the time of the service (no path yet) unless it is a skin lesion which would require a path. 

How would you bill?

1. 45171, 239.0
2. 46221, 455.2

or 

1. 45171, 455.8
2. 46221, 455.2


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## colorectal surgeon (May 24, 2011)

This sounds like a hemorrhoidectomy to me.  I think that's not right to code a transanal excision for a hemorrhoid.  I would probably code it as anoscopy with biopsy. That's obviously a big difference in work amount.  

Please post the scrubbed op note.


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## acbarnes (May 25, 2011)

Funny because I thought the same thing at first. I originally coded it as a hemorrhidectomy; however, my physician argued that it was not the same thing and pointed out the slight differences in op reports. That is why I ended up calling the American College of Surgeons coding hotline to get their take. The rep hit me with the diagnosis coding 239.0 versus 455.8. I also argued the transanal excision versus hemorrhoidectomy but the op procedure note does read as transanl excision which the physician supported. As you can see I am still nervous about coding it so i am looking for some direction on authorative articles/policy for coding with or without path at time of procedure (not talking about skin lesions which have to be coded with path). 

Still uncertain....

Thanks for the feedback.

Anna


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