Gastroenterology Coding Alert

Question: The gastroenterologist cauterizes three internal hemorrhoids with a heater probe. The next day, the patient calls to complain about severe rectal pain. The gastroenterologist returns the patient to the operating room for a flexible sigmoidoscopy and discovers the patient has bleeding in the hemorrhoid removal area. Which codes should I report on the claim?

West Virginia Subscriber

Answer: First, report 46930 (Destruction of internal hemorrhoid[s] by thermal energy [eg, infrared coagulation, cautery, radiofrequency]) for the initial hemorrhoid treatment with a heater probe. Attach 455.2 (Internal hemorrhoids with other complication) to 46930. Then, report 45334 (Sigmoidoscopy, flexible; with control of bleeding [eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) for the subsequent sigmoidoscopy. You'll attach 569.42 (Anal or rectal pain) and 569.3 (Hemorrhage of rectum and anus) to 45334.

Finally, append modifier 78 (Unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to 45334 to show that the procedure was a return to the operating room to treat complications during the global period of an earlier procedure (the hemorrhoid removal).