General Surgery Coding Alert

Question: If the physician removes multiple hemorrhoids using simple ligature, should I report 46221 for each removal?

Answer: No, you should not report 46221 (Hemorrhoidectomy, by simple ligature [e.g., rubber band]) for each hemorrhoid the surgeon removes by simple ligature. According to the AMA's CPT guidelines, you may code only a single unit of 46221 per session, regardless of the number of hemorrhoids the surgeon removes. Note, however, that if the patient returns later for additional removals, the physician may again report 46221. As a matter of personal preference, some surgeons limit the number of bandings to two or less per session to minimize potential undesired side effects or complications of treatment.