General Surgery Coding Alert
Hemorrhoid Removal With Fissure
Question: During hemorrhoid removal, the surgeon also treated an anal fissure. How should I report this? Nevada Subscriber A fissure which is usually associated with internal or external hemorrhoids is a chronic crack in the anoderm that splits the mucosa and exposes the sphincter muscle. The most common repair method for such fissures is lateral internal sphincterotomy, 46080* (Sphincterotomy, anal, division of sphincter [separate procedure]). If the surgeon performs 46080 with a related procedure, you may not report the procedure separately. For example, the national Correct Coding Initiative bundles 46080 to 46221 (Hemorrhoidectomy, by simple ligature [e.g., rubber band]) and other hemorrhoid removal procedures. Depending on circumstances, the surgeon may choose to perform a fissurectomy. This procedure includes excision of internal and external hemorrhoids, and you should report it with either 46257 (Hemorrhoidectomy, internal and external, simple; with fissurectomy) or 46261 (Hemorrhoidectomy, internal and external, complex or extensive; with fissurectomy), as appropriate.
Answer: The answer depends on exactly what the surgeon did in the operating room. But in all cases, a single code should suffice to report both hemorrhoid removal and fissure treatment.
Alternatively, the surgeon could perform an even more extensive procedure involving full or partial excision of an anal fistula, a passageway that forms when a perirectal abscess caused by an infected crypt drains to the skin. The surgeon may excise the entire fistula (fistulectomy) or remove only the fistula's roof (fistulotomy). Once again, the procedure includes removal of internal and external hemorrhoids, with treatment of fissure if present. Depending on the level of severity, choose between 46258 (Hemorrhoidectomy, internal and external, simple; with fistulectomy, with or without fissurectomy) and 46262 (Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy, with or without fissurectomy).
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