Gastroenterology Coding Alert

Beef up your documentation with details such as depth and type.

Anoscopy (46600) is a method to view the anus, anal canal, and lower rectum. When the GI orders an anoscopy for a patient, one reason may be to determine whether the patient has hemorrhoids (455). Hemorrhoid refers to an enlarged or swollen blood vessel, usually located near the anus or the rectum.

ICD-10 difference: When ICD-9-CM changes to ICD-10-CM in Oct. 1, 2013, code 455 will become I84.x (Hemorrhoids). This new code will further expand into the following subcategories:

• I84.0-, Thrombosed hemorrhoids
• I84.11-, Internal hemorrhoids with other complications
• I84.12-, External hemorrhoids with other complications
• I84.13-, Internal and external hemorrhoids with other complications
• I84.2-, Hemorrhoids without complication
• I84.6, Residual hemorrhoidal skin tags.

Documentation: The treatment/procedure codes for hemorrhoids (e.g., 46221, Hemorrhoidectomy, internal, by rubber band ligation[s]; or 46083, Incision of thrombosed hemorrhoid, external) include terminology such as incision, excision, cauterization, ligation, reduction, and column/group. This means you must understand the terminology and how the procedure is performed.

The provider's documentation should specify whether the hemorrhoids were a single column/group or two or more columns/groups, or whether the hemorrhoids were separately identifiable. The documentation should also identify the depth to which the physician performed the procedure. When in doubt, query your provider to clarify things.

Coder tips: For internal hemorrhoids, the physician may perform a digital rectal exam in the office and may also perform an anoscopy or proctoscopy/sigmoidoscopy, depending on the symptoms. A physician usually diagnoses external hemorrhoids in an office setting with a visual and/or digital inspection around the anal/rectal area. You can code this as a routine office visit with an E/M code.