Gastroenterology Coding Alert

Question: A new patient reports to the gastroenterologist with complaints of rectal bleeding and pain during defecation. After a detailed history and exam, the gastroenterologist finds a pair of internal hemorrhoids. The physician performs hemorrhoidectomy on both with radiofrequency. Should I code for each hemorrhoid destroyed?

Alabama Subscriber

Answer: You cannot code each destruction separately.

On the claim, report the following:

• 46930 (Destruction of internal hemorrhoid[s] by thermal energy [e.g., infrared coagulation, cautery, radiofrequency]) for the hemorrhoidectomy

• 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making ...) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99202 to show that the E/M and hemorrhoidectomy were separate services

• 455.0 (Internal hemorrhoids without mention of complication) appended to 46930 and 99202 to represent the patient's hemorrhoids.