Coding Corner: 5 Tips for Hemorrhoid Removal Coding

Clear-cut distinctions between 9 slippery codes

If you're confused about which hemorrhoidectomy code to choose, when to report single or multiple units, or how to report treatments the usual codes don't cover, follow this expert advice to help you decide.
1. Know the location.
When coding hemorrhoid procedures, the first thing you'll want to do is classify the type of hemorrhoid involved. "Hemorrhoids are either internal or external," says M. Trayser Dunaway, MD, FACS, a general surgeon in Camden, S.C. "In some cases, the surgeon may deal with both kinds during the same session. But whatever the circumstances, the codes you'll report are directly related to the location of hemorrhoids involved."
 
An internal hemorrhoid originates above the dentate line (a mucocutaneous junction that lies about 1 to 1.5 cm above the anal verge), and an external hemorrhoid originates below this line. "If the surgeon does not directly state 'internal' or 'external' hemorrhoid, you can read further into the documentation to see if there is a reference to the dentate line," Dunaway says. If the documentation is unclear, you should be sure to consult with the surgeon before reporting the code.
2. Recognize treatment for common internal hemorrhoids.
For persistent internal hemorrhoids, surgeons have several treatment choices. "By far the most common hemorrhoid removal procedure is simple rubber-band ligature (46221, Hemorrhoidectomy, by simple ligature [e.g., rubber band])," Dunaway says. In this procedure, the surgeon "ties off" (ligates) the hemorrhoid at its base, which cuts off its blood supply and causes it to shrink over time.
 
For patients who require simple hemorrhoid removal by ligature, the surgeon may remove more than one hemorrhoid during the same session. Although some intermediaries may pay for each hemorrhoid a physician removes, most will not. The AMA's CPT Assistant (October 1997) instructs facilities to bill 46221 only once per operative session, regardless of how many hemorrhoids the doctor bands at that time.
 
3. Use unusual codes for unusual internal methods.
Aside from rubber-band ligature, CPT provides codes to describe less-frequent methods of removing internal hemorrhoids, none of which are described by hemorrhoidectomy codes 46221-46262. These include:
 
46500* - Injection of sclerosing solution, hemorrhoids. In this procedure, the surgeon injects a sclerosing solution into the submucosa of the rectal wall under the hemorrhoid. Once again, this reduces blood flow to the area and causes the hemorrhoid to shrink.
46934 - Destruction of hemorrhoids, any method; internal. This is a catchall code to describe any method of destruction other than ligature or sclerosing solution. Such methods could include the use of electrical current or infrared radiation, Dunaway says.
Because the descriptors for both 46500 and 46934 specify "hemorrhoids" (plural), you should report these codes only once per session, regardless of how [...]

- Published on 2003-10-06