Gastroenterology Coding Alert

Question: Our doctor removed two hemorrhoids by simple ligature using 46221. Would I list the code once for multiple hemorrhoids? Usually CPT puts an (s) after the description for multiple removals built into a code.

Pennsylvania Subscriber

Answer: Yes, you will report only a single unit of 46221 (Hemorrhoid-ectomy, by simple ligature [e.g., rubber band]) to describe hemorrhoid removal. AMA's CPT Assistant (October 1997) states, "Each session of rubber-band ligation, regardless of the number of hemorrhoids, is coded once." However, in order to show that your physician removed multiple hemorroids, some payers may require you to append modifier 51 (Multiple procedures).

Exceptions: Many payers will not accept the 51 modifier for a single code. Some will automatically drop the codes; others may deny the claim for improper modifier usage. And there are some Medicare carriers that will pay even though the modifier is attached. Check with your carriers.