General Surgery Coding Alert

Question: Our surgeon saw a patient in the office, and advised a subsequent visit to perform IRC. The surgeon had also performed IRC last month. What is IRC, and how should I code the procedure and the office visit?

Idaho Subscriber

Answer: Surgeons may use Infrared Coagulation (IRC) as an office treatment for internal hemorrhoids. The surgeon 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 more invasive surgical procedures.

The duration of each treatment is only about two 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 should report 46930 (Destruction of internal hemorrhoid(s) by thermal energy [egg, infrared coagulation, cautery, radiofrequency]). This procedure has a 90-day global period, which means that you should include the office visit in between treatments in the initial code. You should not separately bill that visit using an E/M code. You still need to document the visit for the clinical care and recommendations.

If the second IRC occurs within the 90-day global period, you can’t separately bill for it, either. You can separately bill for an additional IRC that occurs beyond the 90 days.