General Surgery Coding Alert

Question: Our surgeon performs internal hemorrhoid ligation using surgical thread. Should we code this as 46221, and can we use multiple units for multiple hemorrhoids?

Texas Subscriber

Answer: No, you should not list the procedure as 46221 (Hemorrhoidectomy, internal, by rubber band ligation[s]). Instead, you should report 46945 (Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group).

Here's why: Because your surgeon uses surgical thread instead of rubber bands, 46945 is the most specific code.

You'll notice that the unit of service is different for the 46221 versus 46945. Because 46221 states, "ligation(s)," you should report only one unit of the code for a single surgical encounter, regardless of the number of internal hemorrhoids that the surgeon ligates using rubber bands.

On the other hand, the unit of service for 46945 is the "single hemorrhoid column/group." But that still doesn't mean you should report multiple units of 46945 for multiple hemorrhoid groups.

Instead: If the surgeon ligates multiple hemorrhoid columns or groups using a method other than rubber band ligation, you should list 46946 (... 2 or more hemorrhoid columns/groups) for the ligations beyond the first.

Watch pay difference: Choosing the wrong hemorrhoid ligation code could cost your practice money. For instance, billing Medicare for internal hemorrhoidectomy by rubber band ligation for two hemorrhoid groups would pay $264.81 for 46221 (non-facility national rate, conversion factor 34.0376), while billing a similar service by surgical thread ligation would pay $308.72 (non-facility national rate, conversion factor 34.0376) for 46946.