# Hemorrhoid banding



## ksb0211 (Jul 14, 2016)

Ok.  So apparently there has been a bit of confusion around here regarding CPT 45398.

If a patient has a colonoscopy (regardless of screening vs diagnostic) and also has a hemorrhoid banding at the same time.  I realize CPT 45398 is likely.  However.....here is an example..............


The patient was brought to the endoscopy room.  Following attainment of sufficient MAC anesthesia, digital examination of the rectum was carried out.  Scope was moved through the rectal vault to the sigmoid colon. .....{yada yada, colonoscopy, biopsies, etc}......  We then went up with the anoscope and banded hemorrhoids X2.

So my question is.....if he actually went BACK IN with the anoscope following the colonoscopy, wouldn't we bill 46221?  The hospital coders are insisting that because it was a colonoscopy primarily that we should use 45398.

I'm a bit frustrated, confused and questioning myself so any insight would help.

Thanks.


----------



## afalcon@dhcla.com (Jul 15, 2016)

when a colon and hemorrhoid banding is done at the same time bill whichever colon code then 46221.
when a flex sig and hemorrhoid banding is done at the same time bill 46221 first then whichever flex sig code second with a -59 modifier.


----------



## pamsbill (Jul 16, 2016)

I think it is a 45398. No one is going to band hemorrhoids with a colonoscope, so of course they would withdraw that scope and use the proper tools for the banding.


----------



## ksb0211 (Jul 21, 2016)

45398
Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)
Per EncoderPro Lay Description: The physician uses a flexible colonoscope to examine the rectum and colon and perform band ligation for hemorrhoids. The physician inserts the scope into the anus and advances the scope into the colon. The lumen of the colon and rectum are visualized. The scope is directed to the affected area. The physician identifies the hemorrhoid. The hemorrhoid is ligated at its base with a rubber band. The hemorrhoid tissue is allowed to slough over time.

46221
Hemorrhoidectomy, internal, by rubber band ligation(s)
Per EncoderPro Lay Description:  The physician performs hemorrhoidectomy by tying off (ligating) an internal hemorrhoid. The physician identifies the internal hemorrhoid. The hemorrhoid is ligated at its base with a rubber band. The hemorrhoid tissue is allowed to slough over time.


I suppose my question is that since he didn't actually use the colonoscope to perform the banding, he used an anoscope, would that NOT be 46221 instead?  I've searched all over for clarification, but cannot find anything.

Thank you so much


----------



## lindsey.hansen (Aug 1, 2016)

I think it's 45398 also.


----------



## pamsbill (Aug 11, 2016)

ksb0211 said:


> 45398
> Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)
> Per EncoderPro Lay Description: The physician uses a flexible colonoscope to examine the rectum and colon and perform band ligation for hemorrhoids. The physician inserts the scope into the anus and advances the scope into the colon. The lumen of the colon and rectum are visualized. The scope is directed to the affected area. The physician identifies the hemorrhoid. The hemorrhoid is ligated at its base with a rubber band. The hemorrhoid tissue is allowed to slough over time.
> 
> ...



No. If the two procedures are performed at the same session, regardless of the equipment used, it is a 45398.


----------



## RobinWomb72 (Apr 17, 2019)

I know this thread is old, but I have had this same issue.  On the professional side for general surgery, I get a charge session for when the surgeon performs an anoscopy with hemorrhoid banding.  The hospital coder gets a separate charge session for the coding of the colonoscopy which is done the same session but withdrawn before the surgeon inserts the anoscope and performs the rubber band ligation.  I have been instructed to code 46221 and the coding analyst for the hospital side removes the 45398, because the two codes hit a CCI bundling edit and no modifier is allowed.  The anoscopy with hemorrhoid banding ligation is a totally different procedure than a colonoscopy OR colonoscopy with hemorrhoid band ligation.  Here is information from CPT Assistant on this issue:

_From CPT Assistant, January 2018, page 7, frequently asked questions

Surgery: Digestive System 


Question: 

 If hemorrhoid banding is performed during a colonoscopy, is code 45398, reported alone, or should codes 45378 and 46221 be reported? The operative note states "Non-bleeding internal hemorrhoids were observed upon retroflexion of the colonoscope. As a separate procedure, the slotted anoscope was inserted, directed toward the column of hemorrhoid to be banded. The hemorrhoid was banded in the usual fashion using the suction ligator with the Barron technique and the right posterior column of hemorrhoids was banded."



Answer: 



Code 45398, Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids), may only be reported if the banding was performed through the colonoscope and if the scope is passed to the cecum. The operative note specifically states that the banding was performed through an anoscope as a separate procedure. Therefore, it would be appropriate to report code 45378, Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure), if the scope is passed to the cecum and the entire colon is examined and code 46221, Hemorrhoidectomy, internal, by rubber band ligation(s), for the hemorrhoid banding. Code 46221 includes diagnostic anoscopy (46600) and, therefore, code 46600 would not additionally be reported.









CPT Assistant © Copyright 1990-2019, American Medical Association. All rights reserved._


----------

