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Gastroenterology Coding Alert

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Use This Hemorrhoid Coding Quick Key

Published on Fri Nov 05, 2004

It's a tough subject, but hemorrhoid knowledge helps the bottom line

If you didn't know that the dentate line is the marker that separates internal hemorrhoids from external hemorrhoids, you might have trouble coding for several hemorrhoid-removal techniques.

Don't let one piece of info send you screaming into the office looking for someone to help; keep this hemorrhoid coding quick key handy for reference instead.

Internal Hemorrhoids Have 4 Levels of Severity

Definition: Internal hemorrhoids occur above the dentate line and are typically lined by rectal mucosa. Rarely, acute severe bleeding requires transfusion, and, occasionally, ongoing chronic losses cause iron- deficiency anemia.

There are four types of internal hemorrhoids:

  •  First degree: The hemorrhoid does not protrude from the anus.

  •  Second degree: The hemorrhoid protrudes from the anus during a bowel movement and returns to the anal canal.

  •  Third degree: The hemorrhoid protrudes from the anus during a bowel movement, but can be pushed back into the anus.

  •  Fourth degree: The hemorrhoid is always outside the anus and cannot be pushed into the anal canal.

    Symptom description: Patients with internal hemorrhoids often describe bright red spotting on the toilet tissue, or blood dripping into the toilet bowl, following defecation. They could also be asymptomatic or have complaints of discomfort, but some form of bleeding is the most common symptom among patients.

    Methods/codes used: When the gastro removes internal hemorrhoids, he will usually use one of the following methods:

  •  rubber-band ligation (46221, Hemorrhoidectomy, by simple ligature [e.g., rubber band])

  •  sclerotherapy (46500, Injection of sclerosing solution, hemorrhoids)

  •  suture ligation (46934, Destruction of hemorrhoids, any method; internal; 46936, ... internal and external).

    Other Internal Removal Methods: You would likely code any other method for internal hemorrhoid removal with 46934 and/or 46936, but contact the payer before filing a claim with these codes for any removal technique other than suture ligation of internal hemorrhoids.

    When Thrombosis Hits, Gastros Treat External Hemorrhoids

    Though internal-hemorrhoid patients are treated most often in gastro offices, gastroenterologists may also perform procedures to treat external ones, especially if the patient has a thrombosed external hemorrhoid.

    Definition: External hemorrhoids occur below the dentate line and are usually covered with squamous epithelium.

    Symptom description: External hemorrhoids are visible without instruments, and patients with external hemorrhoids may have complaints of discomfort, especially if the hemorrhoid has thrombosed. Bleeding usually occurs late in the course of thrombosed external hemorrhoid, after the overlying perianal skin ulcerates and the resolving, liquefied hematoma necessitates.

    Methods/codes used: The physician will likely use one of these methods to treat external hemorrhoids:

  •  incision (46083, Incision of thrombosed hemorrhoid, external)

  •  cauterization (46935, Destruction of hemorrhoids, any method; external; and/or 46936, ... internal and external).

    Code for any other method of external-hemorrhoid removal with 46935 and/or 46936, but contact the payer before filing a claim with these codes for any removal technique other than cauterization of external hemorrhoids.

    Editor's note: Information provided by Arlene Soriano, CPC, coder at Atlanta Gastroenterology Associates LLC.

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