Gastroenterology Coding Alert

Be ready to use an I code to replace 455.0 in 2013.

You would typically report internal hemorrhoids with 455.0 (Internal hemorrhoids without complication), say during a colonoscopy screening when a gastroenterologist notices the hemorrhoids. Come 2013 when ICD-9 transitions to ICD- 10, 455.0 will become I84.21 (Internal hemorrhoids without complication).

ICD difference: The two main complications of hemorrhoids are excessive bleeding (455.2, Internal hemorrhoids with other complication) and thrombosis (455.1, Internal thrombosed hemorrhoids). ICD-9 455.0 pertains to internal hemorrhoids without mention of complication. This and its ICD-10 counterpart I84.21 carry the same descriptor verbatim, and will be used for the same function.

Note: ICD-9 does not classify hemorrhoids by degrees.

Coder tips: If your gastroenterologist destroys internal hemorrhoids with heat, you would bill 46930 (Destruction of internal hemorrhoid[s] by thermal energy [e.g., infrared coagulation, cautery, radiofrequency]) for the procedure. This 2009-born code treats the procedure as major surgery: 46930 has a 90-day global period. So if your gastroenterologist performs thermal hemorrhoid destruction in stages, you'll have to append a modifier or risk losing as much as $203.52 (5.99 RVUs for nonfacility multiplied by 2011 conversion factor of 33.9764).