Gastroenterology Coding Alert

Coding Tips to Help Increase Your Confidence and Reimbursement Gastroenterologists frequently manage hemorrhoids, yet those little devils can prove complicated to code, depending on their type, the number of hemorrhoids, the CPT codes used for treatment, and the location of treatment.
 
Exploring the general issues surrounding hemorrhoid treatment, and examining common "hemorrhoid" scenarios gastroenterologists face, will give you the information - and confidence - to take the burn out of hemorrhoid coding. With these expert tips, you'll report hemorrhoids accurately and to the best advantage of your practice. 1. Know Hemorrhoid Types and Degree
 
When coding for hemorrhoid treatment, your first step is to classify the type of hemorrhoid(s) involved. There are two main types of hemorrhoids: internal (455.0-455.2) and external (455.3-455.5).
  
The eMedicine Web site defines hemorrhoids as "varicosities of the hemorrhoidal venous plexus." Internal hemorrhoids occur inside the anal canal, "above the dentate line, are covered by anal mucosa and lack sensory innervation." Their venous drainage proceeds "into the superior rectal vein, which drains into the portal system." External hemorrhoids develop near the anal opening, "below the dentate line and are covered by stratified squamous epithelium with innervation by the inferior rectal nerve. External hemorrhoids drain into the inferior rectal vein, which drains into the inferior vena cava."
 
Both internal and external hemorrhoids can occur in a patient at the same time. Internal hemorrhoids have four stages of severity:
  First degree: The hemorrhoid does not protrude from the anus.
  Second degree: The hemorrhoid protrudes from the anus during a bowel movement but spontaneously returns to the anal canal afterward.
  Third degree: The hemorrhoid protrudes from the anus during a bowel movement, but you can push it inside the anus with your finger.
  Fourth degree: The hemorrhoid is always outside the anus and cannot be pushed into the anal canal. 2. Choose Treatment for Internal Hemorrhoids The treatments for hemorrhoids - and the codes for hemorrhoid treatment services - differ depending on where they develop. In some cases, hemorrhoids must be treated endoscopically or surgically. These methods are used to shrink and/or destroy the hemorrhoidal tissue. The doctor can perform the procedure in the office, at an ambulatory surgery center, or at a hospital outpatient surgery unit. A gastroenterologist or surgeon can perform the various hemorrhoid procedures depending on the required technical aspects.
 
Gastroenterologists most commonly deal with internal hemorrhoids. GI physicians either see a patient for hemorrhoids at the request of a primary-care physician (PCP) or discover internal hemorrhoids while performing other procedures, says Linda Parks, MA, CPC, CCP, business office coordinator, [...]