Coding for hemorrhoids
Hemorrhoids are simply blood vessels, which require attention only if they become inflamed. Correct hemorrhoid coding depends on documentation that specifies the type:
- Internal
- External, or
- Mixed and number of hemorrhoids treated, as well as the treatment method.
While two codes have been resequenced from the ?Destruction? subhead to appear more appropriately under the ?Excision? subhead Codes to identify treatment for internal hemorrhoids have undergone minor descriptor revisions to clarify application. Other relevant codes are unchanged for 2010, but CPT(R) has added specific instruction for appropriate code application, as outlined below, just after the ?Anus? subhead.
Surgical Treatment: Internal Hemorrhoid Coding-at-a-Glance
Treatment Single Column/Group
Rubber band ligation 46221
Other Ligation (suture) 46945
Sclerosing Injection 46500
Thermal energy 46930
Cryosurgery 46999
Hemorrhoidopexy 46947
Treatment Multiple Columns/Groups
Other Ligation (suture) 46946
Report only a single code unit, regardless of how many hemorrhoids are treated.
External Hemorrhoid Coding-at-a-Glance: Surgical Treatment
Thrombosed = Yes
Single Column/Group 46320
Multiple Columns/Groups 46320 x number of hemorrhoids excised
Thrombosed = No
Single Column/Group 46999
Multiple Columns/Groups 46250
Note that a surgeon may choose to treat a thrombosed external hemorrhoid simply by draining (by incision) the clot only, after which the varicose hemorrhoid may resolve on its own. Report such a procedure using 46083 Incision of thrombosed hemorrhoid, external.
An external thrombosed hemorrhoid may resolve into a skin tag or papilla, which the surgeon may remove. Removal of a single tag/papilla is reported with 26220 Excision of single external papilla or tag, anus, while removal of two or more tags/papillae is reported with 26230 Excision of multiple external papillae or tags, anus. Report only a single unit of 26230 per claim, and never report 26220 and 26230 on the same claim.
Surgical Treatment: Mixed Hemorrhoid Coding-at-a-Glance.
Coding for so-called ?mixed hemorrhoid? treatment depends on both the number of groups/columns treated, as well as any related procedures performed at the same time.
Mixed Hemorrhoid Single Column/Group
Excision Alone 46255
With Fissurectomy 46257
With fistulectomy (fissurectomy when performed) 46258
Mixed Hemorrhoid Muliple Columns/Groups
Excision Alone 46260
With Fissurectomy 46261
With fistulectomy (fissurectomy when performed) 46262