General Surgery Coding Alert

Question: Our surgeon treated a patient with two internal hemorrhoids that protruding through the anus. The treatment involved dividing the sphincter and banding the two hemorrhoids. Should we code 46221 x 2 and 46080?

Washington Subscriber

Answer: You should report only one instance of 46221 (Hemorrhoidectomy, internal, by rubber band ligation[s]) for the procedure you describe.

Multiple hemorrhoids: You'll notice that 46221 describes "ligation[s]," meaning that you should report only one unit of the code whether the surgeon bands one or multiple internal hemorrhoids.

Sphincterotomy included: CPT® classifies 46080 (Sphincterotomy, anal, division of sphincter [separate procedure]) as a "separate procedure," which means that you can't bill for the service if the physician performs the procedure with a related procedure such as hemorrhoidectomy.

Also, Correct Coding Initiative (CCI) edits bundle 46221 as a column 2 code with 46080. CCI lists the edit pair with a modifier indicator of "0," meaning that you cannot bill the codes together under any circumstances.

Internal versus external: Even though the hemorrhoids protrude through the anus, you're correct to select 46221 rather than an external hemorrhoid code (such as 46250, Hemorrhoidectomy, external, 2 or more columns/groups)

Internal hemorrhoids arise in the mucosa-lined intestinal tissue proximal to the dentate line. External hemorrhoids arise in squamous cell anal tissue distal to the dentate line. The origin classifies the hemorrhoids, not whether the tissue protrudes through the anus..