General Surgery Coding Alert

Master code addition and revisions.

CPT^® 2020 delivers some changes you need to know for reporting your surgeon’s work for internal hemorrhoid excision procedures.

Read on to make sure you catch the new code, two revised codes, and even a deleted Category III hemorrhoidectomy code.

New Code Leads Change

CPT^® 2020 debuts a new code that gives you an option if your surgeon performs transanal dearterialization of two or more hemorrhoid columns or groups:

• 46948 (Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed)

Note that this new code includes ultrasound guidance, so you should adhere to the new text note banning you from reporting the code with 76872 (Ultrasound, transrectal), 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) or 76998 (Ultrasonic guidance, intraoperative).

Mucopexy: Code 46948 also includes mucopexy, when performed, which involves recto-anal lifting.

Single column: Because the 46948 definition describes a service for “2 or more hemorrhoid columns/groups,” you should not use the code if the surgeon treats a single column. A text note following the new code states, “For transanal hemorrhoidal dearterialization, single hemorrhoid column/group, use 46999 (Unlisted procedure, anus).”

Clarify Imaging For Existing Codes

You’ll find two revised hemorrhoidectomy codes in CPT^® 2020 with the added language underlined as follows:

• 46945 (Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group; )
• 46946 (… 2 or more hemorrhoid columns/groups; )

In addition to adding the clarification the procedures don’t involve imaging guidance, CPT^® 2020 adds a new note following 46946 stating, “Do not report 46945, 46946 in conjunction with 76872, 76942, 76998.”

Tip: “Coders must understand the importance of reviewing the revised CPT^® codes the AMA publishes each year — since the result of using a code description that has been revised could be that the claim does not get paid,” says Ronda Tews, CPC, CHC, CCS-P, AAPC Fellow, director of billing and coding compliance at Modernizing Medicine in Boca Raton, Florida.

In this case, the revisions 46945-46946 revisions point to new code 46948, which does include imaging guidance.

Stop Using ‘Temporary’ Code

CPT^® 2020 deletes Category III code 0249T (Ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance).

If your surgeon performs that procedure, you should report 46948 in its place beginning Jan. 1 according to CPT^® instruction.