Hemorrhoid Coding Made Easy

Hemorrhoid Coding Made Easy

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.
Codes to identify treatment for internal hemorrhoids have undergone minor descriptor revisions to clarify application, while two codes have been resequenced from the “Destruction” subhead to appear more appropriately under the “Excision” subhead. Other relevant codes are unchanged for 2010, but CPT® 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                        Multiple Columns/Groups
Rubber band ligation                    46221*
Other Ligation (suture)                 46945                                                  46946
Sclerosing Injection                       46500*
Thermal energy                              46930*
Cryosurgery                                    46999*
Hemorrhoidopexy                        46947*
* Report only a single code unit, regardless of how many hemorrhoids are treated

Surgical Treatment: External Hemorrhoid Coding-at-a-Glance

Thrombosed?            Single Column/Group                  Multiple Columns/Groups
Yes                               46320                                                46320 x number of hemorrhoids excised
No                                46999                                                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 46220 Excision of single external papilla or tag, anus, while removal of two or more tags/papillae is reported with 46230 Excision of multiple external papillae or tags, anus. Report only a single unit of 46230 per claim, and never report 46220 and 46230 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.
Single Column/Group
Excision Alone        With Fissurectomy           With fistulectomy (fissurectomy when performed)
46255                         46257                                    46258
Multiple Columns/Groups
Excision Alone        With Fissurectomy             With fistulectomy (fissurectomy when performed)
46260                       46261                                       46262

John Verhovshek
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About Has 584 Posts

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

8 Responses to “Hemorrhoid Coding Made Easy”

  1. Connie Morrison says:

    There is no 26220 in the CPT book and 26230 is “Partial excision (craterization, saucerization or diaphysectomy) bone (e.g.. osteomyelitis; metacarpal. 46220 and 46230 are for the tags.

  2. Eileen R says:

    I think you meant to say 46220 and 46230, NOT 26220 and 26230.

  3. Becki P. says:

    How would you advise coding internal hemorrhoid destruction using the Ultroid Device? (This is a Non-thermal energy producing device.) The manufacturer suggests 46930 but some physicians are coding it as 46999. How do you suggest? Also, all MUE/Units limitations would still apply, correct? (Once per Service Date for Internal hemorrhoids) and CPT 46600-59 would still deny as inclusive since an NCCI edit?

  4. ASaiz says:

    Thank you for your comment. You’ll find a lot of suggestions and better answers to your question in the Member Forums.

  5. Becki P. says:

    Hi ASaiz,
    I’ve already asked my question in the member forum and no one really can assist me. I received some information, but not anything that really addresses my question to the degree in which it needs. I was hoping that the author of this blog could respond or refer me to some documentation that my support my issue.

  6. Fola D says:

    @ Becky P et al. July 2016 CPT Code Assistant has clarified code 46930 has the correct code for internal hemorrhoid destruction using the Ultroid Device.

  7. D Shapiro MD says:

    What is the correct code for the HET procedure

  8. Pamela says:

    is it ok to bill cpt code 46030 and 46999 Anal Fistula for sep reimbursement.