Question: Is sphincterotomy included in hemorrhoidectomy?
New York Subscriber
Answer: The National Correct Coding Initiative (version 12.2, released July 1, 2006) bundles 46221 (Hemorrhoidectomy, by simple ligature [e.g., rubber band]) and 46320 (Enucleation or excision of external thrombotic hemorrhoid) to sphincterotomy (46080, Sphincterotomy, anal, division of sphincter [separate procedure]). These edits include a “0” modifier indicator, meaning that you can’t unbundle the code pair.
Therefore, if the surgeon performs the procedures described by 46221 (or 46320) and 46080 at that same time, you can only report the more extensive procedure (in this case, the sphincterotomy, 46080).
In addition: CPT classifies sphincterotomy (46080) as a “separate procedure,” so you cannot bill for it if the surgeon performs any related procedures, including hemorrhoidectomy and related procedures 46230-46288.
For example, if the surgeon excises three external hemorrhoids and performs a sphincterotomy at the same time, you may report only 46250 (Hemorrhoidectomy, external, complete) because the sphincterotomy is included in any related procedure.
The NCCI confirms this practice by bundling 46080 to 46250 (with a “0” modifier indicator) as well as all codes in the 46200-46288 range (except 46221 and 46320, which, as explained above, are bundled to 46080).
If, however, the surgeon excises the hemorrhoids and then, several months later, returns to the operating room to perform only sphincterotomy for the same patient, you can report 46250 for the first surgery and 46080 for the second.
