Gastroenterology Coding Alert

READER QUESTIONS:

Multiple-Papillae? Choose 1 Hemorrhoidectomy Code

Question: I am a bit confused by this op report: A patient with external hemorrhoids and an anal fistula reports for "papillae destruction in 3 areas near anus." How do I code this procedure?

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Answer: There is a specific code for this type of hemorrhoidectomy. On the claim, report 46230 (Excision of external hemorrhoid tags and/or multiple papillae) for the procedure. Append 569.49 (Other specified disorders of rectum and anus; other) to 46230 to represent the patient's papillae, 565.1 (Anal fistula) for the patient's fistula, and 455.3 (External hemorrhoids without mention of complication) to represent the patient's hemorrhoids.

Definition: According to www.hemorrhoid.net, "anal papillae are prominent projections of epithelium at the upper end of the anal canal at the mucocutaneous junction. Usually, they are small, but visible enough to give  the pectinate line a serrated appearance on anoscopy." Since the patient presented for the papillae destruction, be sure to list this diagnosis ahead of 565.1 and 455.0.

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