General Surgery Coding Alert

Question: How can I code treatment of anal fissure during hemorrhoid removal?


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Answer: You can choose from a number of possible codes, depending on exactly what the surgeon did in the operating room.

A fissure is a chronic crack in the anoderm that splits the mucosa and exposes the sphincter muscle. The most common repair for fissures is a lateral sphincterotomy, 46080 (Sphincterotomy, anal, division of sphincter [separate procedure]).

Note, however, that if the surgeon performs 46080 with a related procedure, you may not report the procedure separately. For example, the National Correct Coding Initiative (NCCI) bundles 46080 to 46221 (Hemorrhoidectomy, by simple ligature [e.g., rubber band]) and other hemorrhoid removal procedures. Therefore, you should not report sphincterectomy separately with hemorrhoid removal.
 
In other cases, the surgeon may instead perform fissurectomy. This procedure includes excision of internal and external hemorrhoids, and you should report using either 46257 (Hemorrhoidectomy, internal and external, simple; with fissurectomy) or 46261 (Hemorrhoidectomy, internal and external, complex or extensive; with fissurectomy), as appropriate.
 
Finally, the surgeon could perform an even more extensive procedure involving full or partial excision of an anal fistula, a passageway that forms when a perirectal abscess caused by an infected crypt drains to the skin. The surgeon may excise the entire fistula (fistulectomy) or remove only the fistula's roof (fistulotomy).

Once again, these procedures include removal of internal and external hemorrhoids, with treatment of fissure if present. Depending on the level of severity, choose between 46258 (Hemorrhoidectomy, internal and external, simple; with fistulectomy, with or without fissurectomy) and 46262 (Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy, with or without fissurectomy).  - 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.