# NON-thermal destruction of hemorrhoids 46999/46930/46945/46946 (?)



## CoderinJax (Jan 12, 2016)

Hi!
 I need some assistance. I have a physician billing CPT code 46999 (unlisted anus procedure) for non-thermal destruction of hemorrhoids. He is using "direct current" as the source, but telling me it's not your regular RF to destroy it. Does anyone else have a Physician in your practice that has notes that state this? I've never seen/heard of this manner to remove/destroy hemorrhoids. I've looked at code 46930, but it states "thermal" energy and he's saying he uses "non thermal" . Anyone have any ideas if 46999 is the correct/closest CPT code?
Thank you!


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## CodingKing (Jan 12, 2016)

I'm not sure about the code but I found some information about the technique on Medscape:

http://www.medscape.com/viewarticle/805040_7



> The direct current probe (Ultroid; Ultroid Technologies, Inc, Tampa, FL) is said to not be a thermal device, but rather it causes the production of sodium hydroxide at the negative electrode of the device, creating the desired tissue effects.[31] Treating hemorrhoids by using direct current technology is limited by the large amount of time necessary to treat the involved tissue, up to 14 minutes per site, and this depends on the grade of the hemorrhoid and the milliamperage tolerated by the patient (110 V up to 16 mA).[9,80] This technique has had limited application because of postprocedure pain that occurs in up to 20% of patients, poor control of prolapse, and the prolonged treatment time.[77] Postprocedural ulcers with bleeding have also been reported. In randomized trials that used this technique, hemorrhoidal bleeding was controlled in 88% of patients.[9]


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## CoderinJax (Jan 13, 2016)

Interesting, and thank you for that. My Doc is also billing an Anoscopy (46600-59) every single time he sees the patients, which I feel like is not appropriate since he has to use this in order to treat the patient's hemorrhoids. (Sigh.....)


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## CodingKing (Jan 13, 2016)

Anoscopy its bundled into the hemorrhoid destruction procedures. NCCI doesn't even allow a modifier to bypass the edit for the code combo.


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## CoderinJax (Feb 5, 2016)

*Following up. Answer found.*

After some further research, and reaching out to other Physician's and resources, it appears my Dr. should have been coding CPT code 46930 for the Ultroid method. The manufacturer of the machine states this in all of their literature. Thank you guys for all of your help in this! Glad to have resolution.


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## CoderinJax (Aug 10, 2016)

*UPDATE: Ultroid device- Internal hemorrhoid destruction*

Hello all,

I have been involved in fairly extensive research in regards to providers billing unlisted CPT code 46999 instead of 46930 when using the Ultroid device, and I wanted to provide the final update. 

I was involved in an audit of a few providers billing unlisted CPT code 46999 (2 units, for every single service date), as well as CPT 46600-59 on every claim. The physician's argument was that the Ultroid Device uses "non-thermal" energy and the description of CPT code 46930 states "thermal". I worked with a contact who addressed with the AMA/CPT Editorial board as to what the initial intent of code 46930 was. The intent was to include the services performed using the Ultroid hemorrhoid device, but the CPT code came across somewhat misleading. 
However, in the July 2016 CPT Assistant, the question was addressed to the AMA to put this issue to rest, and they clarified that CPT code 46930 is the appropriate CPT code to be using for this device, since it uses DC (Direct Current). (See July 2016 CPT Assistant, Volume 26, Issue 7 for the Q&A.)

The physicians were also incorrectly billing multiple units, as internal hemorrhoid destruction codes have an MAU/MUE of once per service date (Based on the CPT codes descriptions), as well as getting paid for the anoscopy code, which has an NCCI Edit to deny when billed with internal hemorrhoid destruction codes. These issues have been addressed and the affected providers were notified.

I hope this helps with any other Physician's offices, as well as Payers that may be using this device.


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