Gastroenterology Coding Alert
How Do We Differentiate Ligation from Excision?
Question: Our GI physician typically documents hemorrhoid “ligations,” but this week we got a chart with a hemorrhoid “excision,” and we aren’t sure if those are the same. Can you advise? Codify Subscriber Answer: You’re correct to be suspicious about the verbiage being different, because these terms do not describe the same thing. An internal hemorrhoid excision is not the same as an internal hemorrhoid ligation. CPT® provides distinct codes for the procedures. For a ligation of multiple internal hemorrhoids, you would report 46946 (Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups, without imaging guidance) or 46221 (Hemorrhoidectomy, internal, by rubber band ligation(s)). But for excision of the same hemorrhoids, you should report 46260 (Hemorrhoidectomy, internal and external, 2 or more columns/groups). Among the confusion surrounding this issue is the code definition for 46260, which states “internal and external.” However, a CPT® text note in the introduction to the “Anus” subsection states: “For excision of internal and/or external hemorrhoid(s), see 46250-46262, 46320.” That means you can legitimately report these codes for either internal or external hemorrhoids alone, not just when both types are present.
Gastroenterology Coding Alert
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