Wednesday, March 24, 2021

Coding Hemorrhoidectomies

The focus of this edition of “Spotlight on CPT” is on hemorrhoidectomy procedures.  Veins in the rectum or anus that have become enlarged and inflamed are called hemorrhoids.  Conditions that may cause hemorrhoids are obesity, pregnancy, prolonged sitting, or straining to facilitate a bowel movement.  Hemorrhoids, especially external ones, may be painful and are prone to bleeding.  If conservative treatment, such as taking fiber supplements or increasing fiber in the diet, increasing fluid intake, exercise, sitz baths, or topical treatments fail, then a surgical procedure may be necessary.

When coding professionals assign codes for hemorrhoidectomy procedures, they must determine if the hemorrhoids are internal, external, or both, and the method of removal.  Depending on that information, other vital information is how many columns of hemorrhoids are removed and if any other procedures such as fistulectomy or fissurectomy are performed at the same time. 

Internal hemorrhoid removal alone is first broken down by method of removal.  If the rubber band ligation is employed, then 46221 is assigned regardless of the number of band ligations performed.  If ligation is by a method other than rubber band, then a further distinction is made based on the number of columns removed.  Removal of one column codes to 46945; two columns codes to 46946.  Of note, both of these codes can be utilized if no imaging guidance is performed. 

A new code for 2020 is the removal of hemorrhoids by transanal dearterialization involving two or more columns.  Code 46948 is assigned to capture this procedure which would include ultrasound guidance and mucopexy if performed.  If only one column of internal hemorrhoid is removed in this fashion, the unlisted code 46999 should be assigned.

There are a few codes for the removal of external hemorrhoids alone.  Code 46320 would be for a thrombosed external hemorrhoid specifically.  This means that a clot has formed in the vein.  This type of hemorrhoid is especially painful.  If two columns of external hemorrhoids are removed, then 46250 is assigned.  Should only one column of external hemorrhoids be removed, then the unlisted code 46999 is appropriate.    

When both internal and external hemorrhoids are removed at the same time, the coding distinguishes between a single column (46255-46258) or two or more columns (46260-46262) and if additional procedures (fissurectomy, fistulectomy) are performed at the same time. 

Now, light has been shed on coding hemorrhoidectomies.


About the Author 
Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.