** This post was reviewed and updated on December 17, 2023. **

The Coding Challenge

Question: A 38-year-old female with a history of discomfort due to external hemorrhoids and intermittent bleeding is seen today with a complaint of an external hemorrhoid. She previously had a colonoscopy, and the results came back normal. The patient is diagnosed with external hemorrhoid with thrombosis, and an excision of the blood clots is performed. Assign the CPT code(s).

A. 46999
B. 46083, 46320
C. 46250
D. 46320

Answer:

D. 46320

Coding For Excising External Hemorrhoids (CPT)

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 the Correct CPT Code

Coding for the excision of external hemorrhoids with thrombosis starts by looking in the CPT coding manual Index under Anus/Hemorrhoids/Clot Excision, 46320. This code can then be verified in the Tabular as:

46320, Excision of thrombosed hemorrhoid, external

There are other ways that may take you to the same code. For example, if we look up Anus/Excision/Hemorrhoids/Clot Excision, it will take us to 46320.

Incorrect Answers

A, B, and C are incorrect. 

A. 46999 refers to Unlisted procedure, anus.

B. 46083, 46320. 46083 refers to Incision of thrombosed hemorrhoid, external. However, as explained above, this part of the procedure is covered by code 46320.

C. 46250 refers to Hemorrhoidectomy, external, 2 or more columns/groups.

How is an Excision of an External Thrombosed Hemorrhoid Procedure Performed?

According to Find-A-Code, an excision of an external thrombosed hemorrhoid is carried out as follows:

1. The patient’s perianal tissue is examined, and the extent of hemorrhoidal disease is evaluated by use of an anoscope.
2. The area is then cleansed and injected with a local anesthetic at the base of the hemorrhoid.
3. An incision is made in the roof of the hemorrhoid to drain and evacuate the blood clot(s).
4. An excision is then performed using an elliptical incision to remove the entire external hemorrhoid, along with any residual hemorrhoidal tissue.
5. Bleeding is controlled by pressure or electrocautery, and the surgical wound is sutured closed or left open to heal.

Two Parts to The Hemorrhoid Procedure, One Code

There are two parts to this procedure. First, an incision and drainage were done, and then the excision was performed. This fact may lead a medical coder to think that since there is a code for incision of a thrombosed hemorrhoid, external (46083), then 46083 should be assigned as well as 46320 for the excision of the external thrombosed hemorrhoid. his would be incorrect. However, this would be incorrect, as the incision and drainage are part of the excision procedure and are 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.

How Did You Do on the Coding Exercise?

If you aced the coding CPT coding challenge on excising external thrombosed hemorrhoids, great job!!   If you had a little trouble, no problem. You’ll get there!

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