General Surgery Coding Alert

Question: Our surgeons recently started treating some internal hemorrhoids with “radio wave ablation.” Previously, most hemorrhoidectomies in our practice were by ligation or suture, but I don’t think we can use those codes for the new process. Should we report an unlisted code such as 46999 for this radio wave ablation hemorrhoidectomy procedure?

Alabama Subscriber

Answer: No, you shouldn’t use the unlisted anus code (46999, Unlisted procedure, anus), because CPT^® provides a specific code for the procedure you’re describing. That code is 46930 (Destruction of internal hemorrhoid[s] by thermal energy [e.g., infrared coagulation, cautery, radiofrequency]).

You should use 46930 for any type of thermal energy instrument, such as a bipolar electro-thermal device, atomizer wand, infrared photocoagulation mechanism, or radiofrequency generator. These methods use thermal energy to destroy the hemorrhoids by coagulation and cauterization, not by direct ligation, or “strangling” of the hemorrhoid.

You are correct that the codes you currently use for internal hemorrhoidectomy by ligation or suture are inappropriate to report radiofrequency ablation (RFA) hemorrhoidectomy. The internal ligation and suture codes you should continue to use for those procedures are as follows:

• 46221 — Hemorrhoidectomy, internal, by rubber band ligation(s)
• 46945 — Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group
• 46946 — … 2 or more hemorrhoids columns/groups.