Gastroenterology Coding Alert

Hint: Know the difference between first- and second-degree hemorrhoids.

In some cases, coding hemorrhoid visits at your GI practice can be straightforward and simple. But in other situations, selecting the right code can create confusion. We’ve gathered a few of the most common questions we receive about this service – read on to find out what they are, and to get the answers on how to code these visits.

Excised Internal Hemorrhoid

Question:  Our gastroenterologist excised a second-degree internal hemorrhoid group due to uncontrollable rectal bleeding. How should we code this?

Answer: For the surgical procedure, you should report 46255 (Hemorrhoidectomy, internal and external, single column/group).

The most specific ICD-10 code for the case is K64.1 (Second degreehemorrhoids). You should use this code because the physician documented that these are bleeding, second-degree hemorrhoids, which means that they prolapse but retract spontaneously.

Without that specific information in the op report, the coder would have to choose a less-specific code, such as K64.9 (Unspecified hemorrhoids).

Takeaway: Code the condition to the highest degree of specificity that you can, considering all the diagnostic information in the op report.

Sigmoidoscopy With Ligation

Question: The GI physician performed a flexible sigmoidoscopy for a patient who presented with rectal bleeding. The doctor diagnosed internal hemorrhoids and performed band ligation. How should we code this?

Answer: The correct code for the procedure is 45350 (Sigmoidoscopy, flexible; with band ligation[s] [eg, hemorrhoids]).

A sigmoidoscopy refers to a procedure in which the gastroenterologist accesses the rectum and lower one third of the colon with a flexible sigmoidoscope, which is a tubular instrument with a light source and camera.

If the gastroenterologist had found nothing that required a therapeutic intervention, you would instead report 45330 (Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)).

Diagnosis: You don’t give a lot of detail, so the most specific ICD-10 code you could report for this case would probably be K64.8 (Other hemorrhoids). Although you do provide documentation of bleeding, without specific information regarding prolapse or mention of hemorrhoid “degree,” you can’t accurately apply a more detailed code such as one of the following:

• K64.0 (First degree hemorrhoids)
• K64.1 (Second degree hemorrhoids)
• K64.2 (Third degree hemorrhoids)
• K64.3 (Fourth degree hemorrhoids).  

Ligation Vs. Excision

Question: Could you please explain appropriate coding for a surgical note describes an “excision” of two internal hemorrhoid columns? I’m familiar with the hemorrhoid “ligation” codes, and I’d like to know if this is the same thing.

Answer: No, an internal hemorrhoid excision is not the same as an internal hemorrhoid ligation. CPT^® provides distinct codes for the procedures.

For a ligation of multiple internal hemorrhoids, you would report 46946 (Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups) or 46221 (Hemorrhoidectomy, internal, by rubber band ligation[s]).

But for excision of the same hemorrhoids, you should report 46260 (Hemorrhoidectomy, internal and external, 2 or more columns/groups).

Don’t worry: Although the code definition states “internal and external,” a CPT^® text note in the introduction to the “Anus” subsection states, “For excision of internal and/or external hemorrhoid(s), see 46250-46262, 46320.” That means you can legitimately report these codes for either internal or external hemorrhoids alone, not just when both types are present.