Gastroenterology Coding Alert
Sigmoidoscopy + Hemorrhoidectomy With Ligation Gets a New Address
Question: Our GI was performing a flexible sigmoidoscopy on a patient in our office, and he discovered internal hemorrhoids. The physician decided to remove the hemorrhoids and excised two hemorrhoids using with rubber-band ligation (three rubber bands). Should I code this procedure with 45330 and 46221?
Minnesota Subscriber
Answer: No. CPT® 2015 has introduced a special code for such an occurrence. You should report 45350 (Sigmoidoscopy, flexible; with band ligation[s] [eg, hemorrhoids]). Earlier, it would have been correct to code 45330 (Sigmoidoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]) for the main procedure, flexible sigmoidoscopy and the hemorrhoid removal with code 46221 (Hemorrhoidectomy, internal, by rubber band ligation(s)). However, the special sigmoidoscopy code 45350 replaces the earlier combo. Keep in mind that no matter how many hemorrhoids are removed during a session, you can bill only once for 45350. Also, 46221 cannot be separately reported with 45350.
Gastroenterologists may come across internal hemorrhoids while performing a sigmoidoscopy, as you described. When this happens, you are correct to code for the hemorrhoidectomy. The 2015 code set adds 45350 for a flexible sigmoidoscopy with band ligation of a structure such as a hemorrhoid. The addition of 45350 is part of a larger 2015 revision to the codes for sigmoidoscopy.
Caution: Ensure from your physician’s notes that a sigmoidoscopy was performed and not colonoscopy, because a similar band ligation service 45398 (Colonoscopy, flexible; with band ligation(s)( e.g., hemorrhoids)) will apply for colonoscopy.
If the gastroenterologist chooses to cauterize the hemorrhoid instead, you can report a separate code. You can use either 46930 (Destruction of internal hemorrhoid[s] by thermal energy [eg, infrared coagulation, cautery, radiofrequency]) or 46999 (Unlisted procedure, anus).
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