General Surgery Coding Alert

Incorporating notes and codes from different sections in CPT can lead to confusion when it's time to pick the right hemorrhoid code -- and choosing the wrong code could cost your practice legitimate pay.

In General Surgery Coding Alert 2010 v12n3, we gave you a step-by-step guide with "Apply 4 Tips to Direct Your Hemorrhoid Coding;" this month we'll pull it all together in one handy chart to guide your hemorrhoid code choice.

You need to pay close attention to text notes and distinguish hemorrhoidectomy codes from other codes in CPT's anus "incision," "excision," and "introduction" sections if you want to capture appropriate reimbursement for your general surgery practice.

For instance: Banding internal hemorrhoids is a more common treatment than excision, according to Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta. But reporting banding if the surgeon uses a different ligation method could cost your practice in lost pay.

That's because the payout for 46221 (Hemorrhoidectomy, internal, by rubber band ligation[s]) guarantees $230, while 46945 (Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group) brings in an average of $257 (based on nonfacility relative value units [RVUs] using the Medicare conversion factor of 36.0846). Maybe the $27 difference doesn't seem like much, but that's not the whole paydifference picture.

Watch single or multiple: "Code 46221 is for multiple hemorrhoids, which means you'll bill the code once no matter how many hemorrhoids the surgeon bands," explains Marcella Bucknam, CPC, CCS-P, CPCH, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program. But if the surgeon ligates multiple hemorrhoid columns or groups by any other method, you should not use 46945, which is for a single column or group. Instead, you should report 46946 (... 2 or more hemorrhoid columns/groups), which pays $271. In that case, choosing the wrong code (46221) could cost your practice $41 in legitimate pay.

Cut out the chart above and place it in the hemorrhoid section of your CPT book to refer to whenever you need to code for these procedures. You can use the chart to help guide your hemorrhoidectomy coding choice.

Here's how: Narrow your code selection by finding the most accurate procedure description in column 2, then identifying any modifying conditions, such as thrombosis, in column 3. Next, check the internal/external column (and footnotes) to determine whether you can use the code for internal and/or external hemorrhoids. Finally, check the "single or multiple" column to see if the code describes a procedure to remove multiple hemorrhoids or a single column or group.

Using the table can help you choose the most accurate code, every time, and minimize "unlisted" code claims. For instance: Looking at the hemorrhoidectomy CPT section, the only apparent code for the excision of one internal hemorrhoid is the unlisted code 46999 (Unlisted procedure, anus), says Sandra Sickler, CPC, CCS, coder with Countryside Surgery Center in Clearwater, Fla. But looking at the table with the footnotes shows that you can use 46255 (Hemorrhoidectomy, internal and external, single column/group) for excision of a single internal and/or external hemorrhoid.