General Surgery Coding Alert

Watch Bundling Issues With Sphincterotomy

Question: Is sphincterotomy included in hemorrhoidectomy?

New York Subscriber

Answer: The National Correct Coding Initiative bundles 46221 (Hemorrhoidectomy, by simple ligature [e.g., rubber band]) to sphincterotomy (46080, Sphincterotomy, anal, division of sphincter [separate procedure]). This edit includes a -0- modifier indicator, meaning that you can't unbundle this code pair.

Therefore, if the surgeon performs the procedures described by 46221 and 46080 at that same time, you can only report the more extensive procedure (in this case, the sphincterotomy, 46080).

In addition: CPT classifies sphincterotomy (46080) as a -separate procedure,- so you cannot bill for it if the surgeon performs any related procedures, including hemorrhoidectomy and related procedures 46230-46320.

For example, if the surgeon excises three external hemorrhoids and performs a sphincterotomy at the same time, you may report only 46250 (Hemorrhoidectomy, external, complete) because the sphincterotomy is included in any related procedure.

The NCCI confirms this practice by bundling 46080 to 46250 (with a -0- modifier indicator), as well as all codes in the 46200-46320 range (except 46221, which, as explained above, is bundled to 46080).

If, however, the surgeon excises the hemorrhoids and then, several months later, returns to the operating room to perform only sphincterotomy for the same patient, you can report 46250 for the first surgery and 46080 for the second.

---Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb