Ligasure Hemorrhoidectomy

[R1CPC]

If the physician notes "Ligasure was used to take the internal hemorrhiodal plexus" Does that mean we can code 46221 Hemorrhoidectomy, internal by rubber band ligation?...do we assume ligasure means rubber band?

 

[jwiles66]

It depends..does the dr mention rubber band? Otherwise, we would normally use 46945 for ligation.

 

[R1CPC]

The report says the following Kelly was placed in the external hemorrhoid. 15 blade was used to come through the external hemorrhoid and the Mezenbaum were used to separate the sphincter mechanism from the internal hemorrhoidal plexus and a LigaSure was used to remove the hemorrhoidal plexus. After this was done, 2-0 Vicryl was tied at the right anterior hemorrhiodal base and then the mucosa was reapproximated in a running locked fashion. The same was done for the right posterior and left lateral hemorrhoidal plexus. So would we bill
46245- for the internal hemorrhoid
46999- for the external hemorrhoid since there is only one column/group or
46255 since NCCI says If multiple services are utilized to treat hemorrhoids at
the same patient encounter, only one HCPCS/CPT
code describing the most extensive procedure may be
reported.