General Surgery Coding Alert

Question: I have a surgical note that states that the surgeon “stapled prolapsed internal hemorrhoids.” Is this 46945, since the hemorrhoids are internal and the surgeon doesn’t use a rubber band?

Georgia Subscriber

Answer: No, you should not use 46945 (Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group) if the surgeon repairs prolapsed internal hemorrhoids by stapling them.

In fact, the procedure you describe is not a hemorrhoidectomy at all, because the surgeon doesn’t remove the hemorrhoids. Instead, the surgeon repairs the prolapse by stapling the hemorrhoids in the anal canal. This procedure is a hemorrhoidopexy.

The correct code for the procedure is 46947 (Hemorrhoidopexy [e.g., for prolapsing internal hemorrhoids] by stapling). You might see the procedure referred to as Procedure for Prolapse and Hemorrhoids (PPH). In PPH, the surgeon performs a progressive anal dilation and inserts a circular anoscope into the anus, then uses a stapling technique to repair the prolapse.

Surgeons may choose to perform PPH instead of the traditional hemorrhoidectomy, especially if the patient hasn’t responded well to more conservative treatment. There’s some evidence that PPH patients experience fewer adverse effects than those undergoing traditional hemorrhoidectomy, including less intense pain following the procedure.