General Surgery Coding Alert

No more unlisted-procedure code for innovative hemorrhoid treatment

To establish medical necessity for hemorrhoidopexy, make sure your surgeon documents the severity of the patient's hemorrhoids as grade III or higher.

Stick With the Dedicated Code

Coding for hemorrhoidopexy, an alternative method for treating prolapsing internal hemorrhoids, has become much easier with the introduction of 46947 in CPT 2005
 
In the past, some providers have successfully billed for hemorrhoidopexy by stapling, for prolapsing internal hemorrhoids - also called the procedure for prolapse and hemorrhoids (PPH) - using an unlisted-procedure code. For 2005, however, you should always report the procedure using the dedicated code 46947 (Hemorrhoidopexy [e.g., for prolapsing internal hemorrhoids] by stapling). A dedicated code will mean more consistent and regular reimbursement for hemorrhoidopexy, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh.
 
During PPH, the surgeon performs a progressive anal dilation and inserts a circular anoscope into the anus, then uses a stapling technique to repair the prolapse. This differs from "traditional" hemmorrhoidectomy, during which the surgeon performs an excision and suture ligation, or rubber-band ligation.
 
Learn more: For information on hemorrhoidopexy and how it differs from hemmorrhoidectomy, see "Digestive System: No More Unlisted-Procedure Codes for Laparoscopic Gastric Bypass," General Surgery Coding Alert, December 2004, pp. 91-93.

Look for a III on a I-V Scale

The most important factor when reporting 46947 is to prove that the physician tried more conservative approaches first.
 
Specifically, Medicare won't cover PPH unless the prolapsed hemorrhoids are at least Grade III on the scale of I to V, says Lori Owens, CPC, insurance supervisor with Ohio Valley Surgical Specialists in Owensboro, Ky.
 
"I haven't had any problems [reporting 46947], and I haven't had to appeal any [claims]," Owens says. For Grade III prolapsed hemorrhoids, chances are the physician has already tried suppositories and has concluded that more aggressive treatment is necessary.

PPH Has Its Benefits

The new hemorrhoidopexy code, 46947, carries 5.20 work RVUs, while existing hemmorrhoidectomy codes 46250-46262 carry work RVUs ranging from 3.88 to 7.49. That means distinguishing between a hemmorrhoidectomy and a hemorrhoidopexy in the physician's chart notes could yield much more reimbursement for the physician's work.