General Surgery Coding Alert

Question: What code is appropriate if the surgeon removes internal hemorrhoids by excision? CPT lists codes for excision of external and "external and internal" hemorrhoids, but nothing for internal only. Should I report the "external and internal" code with a modifier 52?

Florida Subscriber

Answer: A parenthetical note following "destruction of hemorrhoid" codes 46934-46936 directs you to 46250-46262 for hemorrhoid excision. As you note, however, none of the codes in the 46250-46262 range specifically apply to internal hemorrhoids, and refer instead to external or "internal and external" hemorrhoids.

Although you might be tempted to append modifier 52 (Reduced services) to an "internal and external" excision code (such as 46255, Hemorrhoidectomy, internal and external, simple), this is not correct. "Internal and external," in this case, refers to "mixed" hemorrhoids, or those that begin above the dentate line (internally) and coalesce with an external hemorrhoid (which begins below the dentate line) in the same general anatomic location to form a single area of inflammation.

Instead, you should select 46934 (Destruction of hemorrhoids, any method; internal). This is a catchall code that describes all removal methods not elsewhere classified, such as ligation (46945), hemorrhoidopexy (46947) or sclerotherapy (46500). Because another, more precise code doesn't describe excision of internal-only hemorrhoids, 46934 is the answer.