Gastroenterology Coding Alert

Question: I heard gastroenterologists sometimes treat external hemorrhoids, aside from treating internal ones. Can you enlighten me further about this procedure?

Vermont Subscriber

Answer: You heard it right. Gastroenterologists may treat patients with internal hemorrhoids, as well as patients with an external case. Your physician may treat the patient with an incision, in which you should report 46083 (Incision of thrombosed hemorrhoid, external). If the physician treats the patient's hemorrhoids with cauterization, report hemorrhoidectomy (46250-46262), which is the new range of codes for this procedure in 2010.

Caveat: Don't confuse 46083 with 46320 (Excision of thrombosed hemorrhoid, external). While 46083 is for an incision, in which a puncture is made in the hemorrhoid and the blood is allowed to drain, relieving pressure, 46320 describes excision or enucleation, in which the thrombosed area is cut out completely, much like excision of a cyst or tumor. If your gastroenterologist is doing I&D, you should use 46083.