General Surgery Coding Alert

Question: Our surgeon assisted another surgeon from a different practice on a laparoscopic partial colon resection for a patient with Crohn's disease. The other surgeon scrubbed out, and our surgeon proceeded to ligate an internal hemorrhoid. How can I capture the surgical assist and the surgical procedure in the same day?

Answer: Bill the hemorrhoid ligation with 46221 (Hemorrhoidectomy, internal, by rubber band ligation[s]). You should additionally bill the assistant surgery as 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis), but you should append modifier 80 (Assistant surgeon) to this code.

Coding both a surgery and a surgical assist on the same day is not that unusual and should not cause problems.

Link to diagnosis: Make sure to attach the appropriate ICD- 9 code that shows medical necessity for each procedure. For the hemorrhoidectomy, you would report 455.0 (Internal hemorrhoids without mention of complication). The partial colon resection links to the Crohn's disease (555.9, Regional enteritis, unspecified site).