General Surgery Coding Alert

Don't fall victim to the 46934 coding pitfall, especially in 2009. When it comes to choosing a code for the excision of internal hemorrhoids, CPT leaves you with more questions than answers. There is no code specifically for this type of hemorrhoid excision. You might be tempted to report 46934 (Destruction of hemorrhoids, any method; internal) when your general surgeon excises internal hemorrhoids. However, experts advise against that code. Plus, as of Jan. 1, 46934 is a deleted code. So which code should you report to make sure your surgeon gets paid for this procedure? CPT Doesn't Offer a Straight Answer When you see that your surgeon performed a hemorrhoid procedure, you-ll need to dig into his operative report to find out the treatment method and the location of the hemorrhoids. "The coder needs to know how the hemorrhoid was dealt with," says Joseph A. Lamm, office manager for Stark County Surgeons in Massillon, Ohio. "This information immediately narrows the possible codes, based on excision, destruction, sclerosing, or suture. Then the coder would need to know internal, external, or both." The problem: CPT offers you several hemorrhoid excision codes. However, none of them specify that your surgeon only removed internal hemorrhoids.For an excision of an external hemorrhoid, you-ll report 46230 (Excision of external hemorrhoid tags and/or multiple papillae) or 46320 (Enucleation or excision of external thrombotic hemorrhoid). If the surgeon removes non-thrombosed, external hemorrhoids via excision, you should select 46250 (Hemorrhoid-ectomy, external, complete). When your surgeon excises both external and internal hemorrhoids during the same session, you would use 46255 (Hemorrhoidectomy, internal and external, simple) or 46260 (Hemorrhoidectomy, internal and external, complex or extensive). Bottom line: There are specific codes for external excision and the excision of both internal and external hemorrhoids, but there is not a code for internal alone. 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 and get the information in the chart. You can't select a proper code without this knowledge -- and, "as auditors love to say, -If it isn't documented, it didn't happen,-" Lamm stresses. "The state of the hemorrhoid (thrombosed or not) along with the action being taken and the location must all be illustrated," agrees Suzan Berman-Hvizdash, CPC, CPC-E/M, CPC-EDS, physician educator for the University of Pittsburgh and past member of the American Academy of Professional Coders National Advisory Board. "Communication between the coder and the doctor can come through the documentation. There are many techniques for hemorrhoid care and the more information that goes between the coder and the MD the better the code choice will be." Don't Count on [...]