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anal papilla & hemorrhoid--HELP

  1. #1
    Default anal papilla & hemorrhoid--HELP
    Medical Coding Books
    Hi Everyone~
    I am a seasoned coder but very new to general surgery coding and I got bit by code 46221 so now I am a little nervous. My MD is stating I should bill 46211 for this surgery which I don't think is right.

    (condensed)
    Anal papilla r posterior quadrant was sharply excised w/scissors and sutured. Anal canal polyp at anterior midline was also sharply excised with scissors and then cauterized. Defect was closed w/3-0 chronic and bites were taken to also ligate an associated internal hemorrhoid.

    I was thinking I should bill 46945 & 46922-51. What do you think?

    All help is greatly appreciated!!!

  2. Arrow
    Quote Originally Posted by beck627 View Post
    Hi Everyone~
    I am a seasoned coder but very new to general surgery coding and I got bit by code 46221 so now I am a little nervous. My MD is stating I should bill 46211 for this surgery which I don't think is right.

    (condensed)
    Anal papilla r posterior quadrant was sharply excised w/scissors and sutured. Anal canal polyp at anterior midline was also sharply excised with scissors and then cauterized. Defect was closed w/3-0 chronic and bites were taken to also ligate an associated internal hemorrhoid.

    I was thinking I should bill 46945 & 46922-51. What do you think?

    All help is greatly appreciated!!!

    Hi,

    The reported coded should be 46922 only. Since there is a single papilla and 46220 covers it which itself is a separate procedure. It will be not reported. 46221 is correct for Ligation of internal hemorrhoid. The documentation says" also ligate an associated internal hemorrhoid".If multiple internal hemorohids were present , then 46945 would have been correct. Look at the cdr of 46221 : "The physician performs hemorrhoidectomy by ligation of an internal hemorrhoid. The physician identifies the internal hemorrhoid. The hemorrhoid is ligated at its base usually with a rubber band. The hemorrhoid tissue is allowed to slough over time." The final codes should be 46922 and 46221.

    Thank You
    Last edited by amitjoshi4; 06-23-2008 at 10:43 PM. Reason: Added comments
    Amit Joshi MSc,CPC,CPC-H

  3. #3
    Default
    I am so glad I asked! I completely missed the "s" on that code. These hemorroid procedures are deceptively tricky! Thanks for your help!

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