General Surgery Coding Alert

Question: The surgeon performed two internal and external hemorrhoidectomies. Which CPT code should be used: 46255 (hemorrhoidectomy, internal and external, simple) or 46260 (hemorrhoidectomy, internal and external, complex or extensive)? Could you please provide detailed descriptions of the codes?

Ajay Upadhyay, MD
Fredericktown, Mo.

Answer: The difference between these two codes lies in the words simple and complex or extensive. In Medicodes Coders Desk Reference, the descriptions of 46255 and 46260 are virtually identical. Essentially, both codes involve the surgeon exploring the anal canal and identifying the hemorrhoid column. An incision is made in the rectal mucosa around the hemorrhoids and the lesions are dissected from the underlying sphincter muscles and removed.

To distinguish between these two codes, the physician must make a subjective judgment about which code to use, says Susan Callaway-Stradley, CPC, CCS-P, a coding and reimbursement specialist in North Augusta, S.C. The most common deciding factors would be issues such as size of the hemorrhoid(s), and number of hemorrhoids treated. Coders must discuss with the surgeon the circumstances of the case to determine the correct code. Any code chosen must be supported by documentation, so the operative note should clearly describe the situation if the physician chooses to code 46260.