General Surgery Coding Alert
Don't Miss Combination Code
Question: The op note indicates that during a flexible sigmoidoscopy procedure, the surgeon discovered and treated internal hemorrhoids using rubber band ligation. Should we code 45330 and 46221?
Arkansas Subscriber
Answer: You should not code 45330 (Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed [separate procedure]) and 46221 (Hemorrhoidectomy, internal, by rubber band ligation[s]) for this case.
Instead, CPT® provides a single code for this combination procedure — 45350 (Sigmoidoscopy, flexible; with band ligation[s] [e.g., hemorrhoids]).
Caution: Make sure your surgeon’s notes indicate that the procedure was a sigmoidoscopy, not colonoscopy, because a different band-ligation code applies for a colonoscopy: 45398 (Colonoscopy, flexible; with band ligation[s][ e.g., hemorrhoids]).
Keep in mind that no matter how many hemorrhoids your surgeon removes during a session, you can bill only once for 45350 or 45398.
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