General Surgery Coding Alert

 Location matters more than number for all removal methods With multiple codes to describe hemorrhoidectomy and yet another for hemorrhoidopexy -- a closely related but distinct procedure -- you can easily become overwhelmed when trying to report hemorrhoid removal procedures. Fortunately, you can cut through the confusion by following these four tips. Tip 1: Narrow Selection by Location Before choosing a hemorrhoidectomy code, you must know whether the hemorrhoids the surgeon removed were internal, external or a combination of both types.
 
Internal hemorrhoids are those that originate above the dentate line (a mucocutaneous junction that lies about 1 to 1.5 cm above the anal verge). Codes that may apply for internal hemorrhoid removal include:

 - 46221 -- Hemorrhoidectomy, by simple ligature (e.g., rubber band).
 
This is by far the most common hemorrhoid removal procedure. During the treatment, the surgeon -ties off- (ligates) the hemorrhoid at its base, which cuts off its blood supply and causes it to shrink over time.  - 46500 -- Injection of sclerosing solution, hemorrhoids.

In this procedure, the surgeon injects a sclerosing solution into the submucosa of the rectal wall under the hemorrhoid. Once again, this reduces blood flow to the area and causes the hemorrhoid to shrink.  - 46934 -- Destruction of hemorrhoids, any method; internal.
 
This is a -not otherwise specified- code to describe any method of destruction other than ligature or sclerosing solution. Such methods could include using electrical current or infrared radiation, for instance.
 
External hemorrhoids originate below the dentate line and can call for a greater variety of treatment options (see Tip 2 below).
 
Watch for: Your surgeon's documentation should explicitly state the location of the hemorrhoids he treats. If the documentation is not clear, be sure to ask the surgeon for details. You can't select a proper code without this knowledge.
 
Tip: -If the surgeon used a local anesthetic, that might be a tip-off that he treated an external hemorrhoid because internal hemorrhoids can usually be treated without pain,- says M. Trayser Dunaway, MD, FACS, CSP, CHCO, CHCC, a surgeon, physician and coding educator, and healthcare consultant in Camden, S.C. Tip 2: Look for Evidence of Thrombosis If the surgeon treats external hemorrhoids, you must consider whether the hemorrhoids are thrombosed (clotted), Dunaway says. When treating a thrombosed external hemorrhoid, the surgeon has three options:
 
1. Wait until the hemorrhoid develops into a skin tag and then, if appropriate, remove it. In this case, if the surgeon does remove the skin tag, you should report either 46220 (Papillectomy or excision of single tag, [...]