General Surgery Coding Alert

Question: Could you please explain appropriate coding for a surgical note describes an “excision” of two internal hemorrhoid columns? I’m familiar with the hemorrhoid “ligation” codes, and I’d like to know if this is the same thing.

Florida Subscriber

Answer: No, an internal hemorrhoid excision is not the same as an internal hemorrhoid ligation. CPT^® provides distinct codes for the procedures.

For a ligation of multiple internal hemorrhoids, you would report 46946 (Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups) or 46221 (Hemorrhoidectomy, internal, by rubber band ligation[s]).

But for excision of the same hemorrhoids, you should report 46260 (Hemorrhoidectomy, internal and external, 2 or more columns/groups).

Don’t worry: Although the code definition states “internal and external,” a CPT^® text note in the introduction to the “Anus” subsection states, “For excision of internal and/or external hemorrhoid(s), see 46250-46262, 46320.” That means you can legitimately report these codes for either internal or external hemorrhoids alone, not just when both types are present.

Bonus: Correctly reporting 46260 will earn your practice more pay than if you had erroneously reported 46946 or 46221. The Medicare Physician Fee Schedule payment rates for these three codes are $491.23, $320.81, and $273.90, respectively (national non-facility rate, conversion factor 35.8043).