4 Tip Eliminate the Irritation of Coding Hemorrhoid Removal Procedures
Published on Thu Aug 02, 2007
Location matters more than number for all removal methods
If you're stuck looking for a code for hemorrhoidectomy and yet another for hemorrhoidopexy--a closely related but distinct procedure--help is here.
You can cut through the confusion by following these four tips: Tip 1: Look for Evidence of Thrombosis If the gastroenterologist treats external hemorrhoids, you must consider whether the hemorrhoids are thrombosed (clotted), says M. Trayser Dunaway, MD, FACS, CSP, CHCO, CHCC, a general surgeon, physician and coding educator, and healthcare consultant in Camden, S.C. When treating a thrombosed external hemorrhoid, the gastroenterologist has three options:
1. Wait until the hemorrhoid develops into a skin tag and then, if appropriate, remove it. In this case, if the gastroenterologist does remove the skin tag, you should report either 46220 (Papillectomy or excision of single tag, anus [separate procedure]) or 46230 (Excision of external hemorrhoid tags and/or multiple papillae), depending on whether the gastroenterologist removes a single or multiple tag(s).
2. Perform an incision and drainage (I&D) to remove the clot only. In this circumstance, you would report 46083 (Incision of thrombosed hemorrhoid, external).
3. Perform an excision to obliterate the clot and hemorrhoid at the same time. The best code to describe this procedure is 46320 (Enucleation or excision of external thrombotic hemorrhoid).
Tip: If a patient presents with symptoms of "pain," you are generally dealing with a thrombosed hemorrhoid, Dunaway says.
Non-thrombosed options: If the gastroenterologist removes non-thrombosed, external hemorrhoids via excision, you should select 46250 (Hemorrhoidectomy, external, complete).
For removal of external hemorrhoids by any method other than excision, you should choose 46935 (Destruction of hemorrhoids, any method; external). This code, like 46934, can include electrical current, infrared radiation and other methods. Tip 2: Narrow Hemorrhoidectomy Selection by Location Before choosing a hemorrhoidectomy code, you must know whether the hemorrhoids the gastroenterologist removed were internal, external or a combination of both types.
Internal hemorrhoids are those that originate above the dentate line (a mucocutaneous junction that lies about 1 to 1.5 cm above the anal verge). Codes that may apply for internal hemorrhoid removal include:
• 46221--Hemorrhoidectomy, by simple ligature (e.g., rubber band).
This is by far the most common hemorrhoid removal procedure. During the treatment, the gastroenterologist "ties off" (ligates) the hemorrhoid at its base, which cuts off its blood supply and causes it to shrink over time. • 46500--Injection of sclerosing solution, hemorrhoids.
In this procedure, the gastroenterologist injects a sclerosing solution into the rectal wall's submucosa 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 "not otherwise specified" code to describe any destruction method other than ligature or sclerosing solution. Such methods could include using electrical current or infrared [...]
