Gastroenterology Coding Alert

Answer: Infrared Coagulation (IRC) is currently one of the most widely used office treatment for internal hemorrhoids. The physician uses a small probe to contact the area above the hemorrhoid that exposes the tissue to a burst of infrared light for about one second. This coagulates the veins above the hemorrhoid causing it to shrink and recede. IRC is a simple, painless, and effective alternative to surgical alternatives. 

 

The duration of each treatment is only about 2 minutes and usually patients require several trips a few weeks apart to destroy all the “feeder” veins (the small veins that feed the hemorrhoids). Over time, the hemorrhoids shrink and, in many cases, vanish completely. Even in case of incomplete elimination, the shrinkage usually stops troublesome symptoms such as bleeding, pain, and protrusion.

 

For the procedure itself, you would use code 46930 (Destruction of internal hemorrhoid(s) by thermal energy [eg, infrared coagulation, cautery, radiofrequency]) This procedure has a 90-day global period which means that any office visit for the condition treated is included in the initial code and cannot be billed separately. You still need to document the visit for the clinical care and recommendations. If another IRC is planned then it will need to be done beyond the 90-day period or that service too is included in the initial code.

 

You can report an E/M code also only if the patient reported to the GI with a problem totally separate from the IRC.