Gastroenterology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should I code for hemorrhoid removal?

North Dakota Subscriber
  Answer: The most common method of hemorrhoid removal performed by gastroenterologists is rubber band ligation (RBL). With this method, a ligator is attached to the endoscope and used to draw up the tissue around the hemorrhoid. A rubber band is then discharged from the ligator and wrapped around the hemorrhoid. The band cuts off the circulation, and the hemorrhoid withers within a few days.
 
Code 46221 (hemorrhoidectomy, by simple ligature [e.g. rubber band]) should be used to report an RBL procedure, according to Linda Parks, MA, CPC, lead coder at Atlanta Gastroenterology Associates, a 23-physician practice. The code can be reported only once, even though two bands are often place around a single hemorrhoid, and several hemorrhoids may be ligated during a single session.
 
Some gastroenterologists may use a probe to cauterize the hemorrhoid instead of RBL. The cauterization method will often include the use of laser coagulation, a heater probe or a direct current probe. Code 46934 (destruction of hemorrhoids, any method, internal) should be used to report this type of removal. If the gastroenterologist removes both internal and external hemorrhoids through cauterization, 46936 (destruction of hemorrhoids, internal and external) can be used.
 
If the gastroenterologist discovers the hemorrhoids while performing a lower gastrointestinal endoscopy on the patient, the colonoscopy or flexible sigmoidoscopy should be billed separately.