General Surgery Coding Alert

Question: We have an op note for a hemorrhoidectomy that states that the surgeon “cut and ligated superior hemorrhoid” and also “sutured two other inferior hemorrhoid complexes.” How should we code this service?

Iowa Subscriber

Answer: With the information given, it appears that the correct code is 46260 (Hemorrhoidectomy, internal and external, 2 or more columns/groups). 

Selecting the proper hemorrhoidectomy code requires an understanding of both the anatomy and procedures involved. Also, providing training so that surgeons use CPT^® compatible terminology in the op reports would be helpful.

Superior/Inferior: These terms, which your surgeon used, roughly correspond to internal/external hemorrhoids. The official distinction is that internal hemorrhoids occur above the dentate line, but these hemorrhoids arise from the superior hemorrhoidal vascular plexus. External hemorrhoids occur below the dentate line and are dilations of the inferior rectal vascular network. So the op note indicates that your surgeon ligated internal and external hemorrhoids.

Ligation: Hemorrhoidectomy is a broad term to describe surgery that removes hemorrhoids, but the surgeon can accomplish the job by various methods that are reflected in the CPT^® codes. Ligation — “tying off” — is one method that surgeons use, and it may be accomplished with a rubber band or a suture, for instance. CPT^® provides specific codes for rubber band ligation, but that’s not the method used in this case. The op note specifies that the surgeon “cut and ligated” and “sutured” the hemorrhoids.

Columns: Hemorrhoids occur in “columns” that correspond to the end branches of the hemorrhoidal (rectal) veins located in the left lateral, right anterior, and right posterior positions. Some CPT^® codes distinguish between “single column/group” or “2 or more columns/groups.” Although your op note doesn’t clearly state that the surgeon treated multiple columns, the distinct locations identified provide strong evidence that you should use the code for two or more columns.

Conclusion: The only code that accounts for the internal/external, ligation, and multiple column evidenced in the op report is 46260.