The documentation indicates the hemorrhoid is external, and it has thrombosed (filled with blood clots). Although external hemorrhoids do not often cause symptoms, a thrombosed hemorrhoid can become painful and tender and require treatment. In this case, an excision of the hemorrhoid was performed.
Locate and Verify
In the CPT coding manual Index, look up Anus, hemorrhoids, excision, thrombotic 46320.
This code can then be verified in the Tabular as:
46320, Excision of thrombosed hemorrhoid, external
How is This Procedure Performed?
According to Find-A-Code, an excision of an external thrombosed hemorrhoid is carried out as follows:
The patient’s perianal tissue is examined, and the extent of hemorrhoidal disease is evaluated by use of an anoscope. The area is then cleansed and injected with a local anesthetic at the base of the hemorrhoid. An incision is made in the roof of the hemorrhoid to drain and evacuate the blood clot(s). An excision is then performed using an elliptical incision to remove the entire external hemorrhoid, along with any residual hemorrhoidal tissue. Bleeding is controlled by pressure or electrocautery, and the surgical wound is sutured closed or left open to heal.
Something to keep in mind here: There are two parts to this procedure. First, an incision and drainage was done, and then the excision.
A medical coder might think that since there is a code for incision of thrombosed hemorrhoid, external, (46083), then 46083 should be assigned as well as 46320 for the excision of the external thrombosed hemorrhoid.
However, this would be incorrect, as the incision and drainage is part of the excision procedure and is covered by code 46320.
An exception to this rule would be if these two procedures were performed on different hemorrhoids or at different times of the day.
Code 46320 is assigned to a single column/group. If multiple columns/groups are excised, assign 46320 x the number of hemorrhoids excised.
A, B, and C are incorrect.
46999, Unlisted procedure, anus (A).
46083, Incision of thrombosed hemorrhoid, external (B).
46250, Hemorrhoidectomy, external, 2 or more columns/groups (C).
Various Treatments Performed on Hemorrhoids
There are various treatments used to eradicate hemorrhoids. According to the National Institute of Diabetes and Digestive and Kidney Diseases, hemorrhoid procedures performed in a physician’s office include:
- rubber band ligation
- infrared photocoagulation
Hemorrhoid treatments performed in an outpatient center or hospital include:
- stapling (hemorrhoidopexy)
Complications of hemorrhoids sometimes require treatment as well. These procedures are often performed by surgeons.
CPT Codes for These Procedures
In CPT, the codes for hemorrhoid procedures are located in the Surgical Procedures on the Anus section (46020-46083).
Within this section, the codes are further broken down by incision, excision, introduction, endoscopy, repair, destruction, and other procedures of the anus.
For example, excision procedures on the anus are assigned codes from the 46200-46946 range. They are classified according to the method of treatment and the type of hemorrhoid (internal, external, mixed).
Be sure to review the documentation for the method used to treat the hemorrhoids, the site of the hemorrhoids, the number of hemorrhoids that require treatment, and if there are any associated complications such as prolapse or thrombosis.
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