I don't think you can bill those two codes together, but I think you have other options here. To me it sounds more like a 46260. After the 46947 (hemorrhoidopexy) the patient still had significant external and combined (internal & external hemorrhoidal) disease present, so a formal hemorrhoidectomy ensued. Then describes resections in 3 quadrants. It sounds to me like they're describing "conventional" hemorrhoidectomies there. The NCCI doesn't have your original code pair listed together, but the narrative instructions state "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." If the path report shows those as hemorrhoidectomies, I think it would be a 46260 for the whole thing.
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