General Surgery Coding Alert

Question: The patient presented for a colonoscopy and also mentioned a troublesome external hemorrhoid. The surgeon performed the colonoscopy and external hemorrhoidectomy of an external hemorrhoid tag. Because there’s an NCCI edit for 45378 and 46220, does that mean I can bill only the colonoscopy?

Maryland Subscriber

Answer: The language in the question may be the source of the coding confusion. You call the procedure an external hemorrhoidectomy, but you call the specimen a “hemorrhoid tag.”

Problem: A tag is a skin growth, which is different from a hemorrhoid, which is a swollen vein. The problem may be that you’re using the wrong code when you report a tag excision (46220, Excision of single external papilla or tag, anus).

Instead, you should report 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) for the colonoscopy and 46999 (Unlisted procedure, anus) for the external hemorrhoidectomy.

CPT^® does not provide a distinct code for a single external hemorrhoid, but adds a text note following 46250 (Hemorrhoidectomy, external, 2 or more columns/groups) that says, “for hemorrhoidectomy, external, single column/group, use 46999.”

Caution: If the specimen is actually a tag, you are correct that you can’t bill both services because the National Correct Coding Initiative (NCCI) edit for 45378 and 46220 lists a “0” modifier indicator for the code pair.