Gastroenterology Coding Alert

Question: We have difficulty deciding when to use the two hemorrhoidectomy codes 46255 and 46260. When should we apply each one?

West Virginia Subscriber

Answer: Knowing which code to apply can indeed be confusing from reading the code descriptions for 46255 (Hemorrhoidectomy, internal and external, simple) or 46260 (Hemorrhoidectomy, internal and external, complex or extensive). The key to deciding which code to use is to interpret the words "simple" (46255) and "complex or extensive" (46260).

Using the technique as a deciding factor can be difficult. For both of these procedures, the surgeon explores the anal canal and identifies the hemorrhoid column. Then, she makes an incision in the rectal mucosa surrounding the hemorrhoid and dissects and subsequently removes the lesion(s) from the underlying sphincter muscles.
 
To add to the confusion about which code to use, you can apply either code when an internal or external hemorrhoid is excised. The Coder's Desk Reference describes these two codes as nearly identical; however, 46255 involves a single column and 46260 multiple columns.
 
To decide on the appropriate code, the surgeon must subjectively make a decision based on factors such as the size of the hemorrhoid(s), how many are excised, and any other particular circumstances.

Justify the code you choose with supporting documentation, especially for 46260, where you should document the determining factors in the operative report.