Don’t miss CPT 2010 ‘either/or’ instructions for hemorrhoid location.
You cannot select a hemorrhoidectomy code if you do not know the distinction between internal and external hemorrhoids. Let our experts guide you through the maze of anatomy and coding to help you select the right code.
The location should guide you
According to Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPCP, COBGC, CCC, compliance education manager for the University of Washington Physician Compliance Program, “External hemorrhoids occur outside the ‘anal rim.’ , which is at the distal end of the anal canal”.
On the other hand, “internal hemorrhoids are close to the anal verge and can be much more difficult to diagnose and treat,” he continues.
Important to identify the different types of hemorrhoids is… the dental line. The line is a mucocutaneous junction about a cm above the anal verge and “can be seen separating the anus from the rectum,” says Suzan Berman, CPC, CEMC, CEDC, senior manager for coding and compliance in the departments of surgery and anesthesiology at the University of Pittsburgh Medical Center. Internal hemorrhoids occur above the dentate line and external hemorrhoids occur below the line.
Best bet: Knowing the lingo can help you translate trade notes; however, having your doctor indicate “internal” or “external” will reduce any potential coding errors.
Look for the ‘inner’ split statement
The lack of specific codes for excision of internal hemorrhoids can be perplexing.
For example: “The only code I can think of for excision of an internal hemorrhoid is unlisted code 46999 (unlisted procedure, anus),” according to Sandra Sickler CPC, CCS, coder at Countryside Surgery Center in Clearwater, Florida.
here is a solution: By adding the following text note, this year CPT codes they allow you to use certain codes for internal and/or external hemorrhoids: “For excision of internal and/or external hemorrhoids, see 46250-46262, 46320.” That means you can use 46255 (Hemorrhoidectomy, internal and external, single column/group) for excision of an internal hemorrhoid (or 46260 [… 2 or more columns/groups] for excision of multiple internal hemorrhoids), according to Bucknam.
You could go for 46945 (Hemorrhoidectomy, internal, by ligation other than rubber band; column/group of individual hemorrhoids) or 46946 (… 2 or more columns/groups of hemorrhoids) for certain internal hemorrhoid excisions, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta. Called a “transfixion suture excision,” the surgeon places a crisscross stitch and ties the base of the hemorrhoid with the suture (ligature) to handle the bleeding. The surgeon then excises and removes any remaining hemorrhoids.
one more problem: Your surgeon can remove a thrombosed internal hemorrhoid, however, 46320 (Excision of Thrombosed Hemorrhoid, External) describes a procedure for external hemorrhoids. Under the new text note for internal and/or external codes, you can report 46320 for internal hemorrhoids, Bucknam says.
Follow the ‘external’ rules to choose the correct code
Although the new text note for internal and/or external codes might appear to allow 46255 for a single external hemorrhoid, a separate text note after 46250 states, “for hemorrhoidectomy, external, single column/group, choose 46999 “.
Likewise, for the removal of multiple external hemorrhoids, the more specific code 46250 should be used (Hemorrhoidectomy, external, 2 or more columns/groups) instead of 46260.
Look at the ‘internal and external’ codes for ‘mixed’ deletions
Your surgeon can remove a “mixed” or confluent hemorrhoid that begins above the dental line and extends below it. These hemorrhoids show attributes of internal and external hemorrhoids. You can find out which codes to select by signing up for the General Surgery Coding Alert.