Gastroenterology Coding Alert
Differentiate Hemorrhoid From Anus Tag
Question: A 56-year-old patient presented for a colonoscopy and also mentioned a troublesome external hemorrhoid. The physician performed the colonoscopy and external hemorrhoidectomy of an external hemorrhoid tag. Because there’s an NCCI edit for 45378 and 46220, does that mean I can bill only the colonoscopy? Maryland Subscriber Answer: The language in the question may be the source of the coding confusion. You call the procedure an external hemorrhoidectomy, but you call the specimen a “hemorrhoid tag.” Problem: A tag is a skin growth, which is different from a hemorrhoid, which is a swollen vein. The problem may be that you’re using the wrong code when you report a tag excision (46220, Excision of single external papilla or tag, anus). Instead, you should report 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) for the colonoscopy and 46999 (Unlisted procedure, anus) for the external hemorrhoidectomy. CPT® does not provide a distinct code for a single external hemorrhoid, but adds a text note following 46250 (Hemorrhoidectomy, external, 2 or more columns/groups) that says, “for hemorrhoidectomy, external, single column/ group, use 46999.” Caution: If the specimen is actually a tag, you are correct that you can’t bill both services because the National Correct Coding Initiative (NCCI) edit for 45378 and 46220 lists a “0” modifier indicator for the code pair, which means the codes cannot be reported together under any circumstances.
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Differentiate Hemorrhoid From Anus Tag
Question: A 56-year-old patient presented for a colonoscopy and also mentioned a troublesome external hemorrhoid. [...]
