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Thread: need a little help

  1. #1
    Join Date
    Apr 2007
    Bangor, Maine

    Default need a little help

    AAPC: Back to School
    I have an op note where the patient was having a symptomatic external hemorrhoid removed. While they were in the operating room, they also noticed a long tag superiorly and this was excised. Can I code this seperately or is it incidental to the primary procedure? Can't I use 46230-59?

    Also, the provider did an internal speculum exam which revealed minor internal hemorrhoids. The person that does the pro fee is using 46600. Is that appropriate for this?

    And lastly, there was an addendum done by the physician that said she noticed towards the beginning of the procedure, on the patients buttock, an area of excoriation. The etiology was not clear. It appeared to be a burn, however, the cautery had not been near that site. It was debrided and bactracin applied. Is that something that I can code as well? I came up with 16020, does that sound right? Would that need a modifer as well?

  2. #2


    I don't believe you can bill out 46230 because it is for tagS or multiple papillae (not single). For a single tag you would use 46220 and that is a separate procedure so would be disallowed.

    In regards to the anoscopy, I believe it would be disallowed as it is also considered a separate procedure.

    I am not sure about your third question.


  3. #3


    I'd go with 46610, 11, or 15 depending on the technique used to remove the tag. That covers your scope and the tag, and it's not a seperate procedure, so you can bill the hemorrhoidectomy with a modifier 51. I would assume that you can also bill for the burn debridement if the physician dictated it as a burn debridement.

  4. #4
    Join Date
    Apr 2007
    Bangor, Maine


    Thanks to all who replied! I actually ended up just going with the 46250 which, as I am told, covers the removal of any and all external hemorrhoids and/or tags. I also coded for the debridement. When I asked the coder who added the 46600 codes (she does the pro fees), she told me that was an error on her part and removed it promptly.

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