Thursday 5 January 2017

Hemorrhoidectomy - Procedure Code 46946

46221 Hemorrhoidectomy, internal, by rubber band ligation(s)

HEMORRHOID

CPT and Description 

46221 Hemorrhoidectomy, internal, by rubber band ligation(s)

46250 Hemorrhoidectomy, external, 2 or more columns/groups

46255 Hemorrhoidectomy, internal and external, single column/ group;

46257 Hemorrhoidectomy, internal and external, single column/ group; with fissurectomy

46258 Hemorrhoidectomy, internal and external, single column/ group; with fistulectomy, including fissurectomy, when performed

46260 Hemorrhoidectomy, internal and external, 2 or more columns/groups;

46261 Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy

46262 Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when performed

46930 Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency)

46945 Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group

46946 Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups

Correspondence Language Policy/Example Number 5.40000 - Sequential procedure

For example, if an anoscopy with control of bleeding (CPT code 46614) is unsuccessful and is followed by a complex or an extensive internal and external hemorrhoidectomy (CPT code 46260), only CPT code 46260 may be reported. Therefore, CPT code 46614 is not separately reportable with CPT code 46260.

46946 – Hemorrhoidectomy, internal, by ligation other than rubber band

Hemorrhoidectomy

Coverage, coding and payment for medical procedures and devices can be confusing. This guide was developed to assist with Medicare reporting and reimbursement when performing hemorrhoidectomy via simple (eg, rubber band) ligation

Hemorrhoid Procedures

The hemorrhoidectomy section of the CPT manual now includes revised language that more specifically identifies the procedure(s) than in the past. In addition, that section of the manual includes its share of resequenced codes with reference notes added where the codes would normally be found in their original numerical sequence. 

Those notations direct the user to the appropriate code series for codes currently placed non-sequentially. Examples of the revisions appear in the box below.

The AMA also revised CPT codes 46250, 46255 and 46260, adding descriptive verbiage that identifies the most specific procedure performed.

Note the following CPT verbiage change from 2009 to 2010: 46250
—Hemorrhoidectomy, external, complete

 46250—Hemorrhoidectomy, external, 2 or more columns/groups CPT directs users to report 46999, Unlisted procedure anus, for a hemorrhoidectomy, external, for single column/group. Changes include 46255—Hemorrhoidectomy, internal and external, simple

 46255—Hemorrhoidectomy, internal and external, single column/group 46260—Hemorrhoidectomy, internal and external, complex or extensive

 46260—Hemorrhoidectomy, internal and external, 2 or more columns/groups Sample Revised Language for Hemorrhoidectomy

 46221—Hemorrhoidectomy, internal, by rubber band ligation(s)

 46946—2 or more hemorrhoid columns/groups

 46220—Excision of single external papillae or tag, anus

 46320—Excision of thrombosed hemorrhoid, external

About Hemorrhoid Rubber Band Ligation

Coding for in-office hemorrhoid rubber band ligation can be confusing. This guide was developed to help assist you when billing for the Nexus™ Ligator System. 

Hemorrhoid banding is a procedure that involves placing a rubber band on to the base of the hemorrhoidal tissue, reducing the blood supply. This procedure may require two or three treatments to resolve the patient s hemorrhoids. Coding:

• The suggested CPT code is 46221; Hemorrhoidectomy, internal, by rubber band ligation(s).

• For each hemorrhoid banding secession CPT 46221 should only be reported once, regardless of how many hemorrhoids are ligated. 

The patient does not have to return at fixed intervals for further ligation.

• If billing for an anoscopy, (CPT 46200), please be aware that this is always bundled with the procedure. There is no additional modifier to change this.

Global Period:

• Hemorrhoidectomy (CPT 46221) has a “global period” of 10 days per banding procedure, and therefore it is recommended bringing the patient back after two weeks for additional bandings if needed.

ICD-9-CM Volume 3 code:

49.43 (cauterization of hemorrhoids)

 Diagnosis: 455.4
 Rationale: I chose code 49.43 based on the notation in the  operative report that the physician excised the hemorrhoid with electrocautery and clamping. 

However, you could use code 49.46 (excision of hemorrhoids) since the physician performed a hemorrhoidectomy. I personally believe 49.43 more accurately represents the procedure.

MEDICAL POLICY Transanal Hemorrhoidal  Dearterialization (THD)

GUIDELINES

This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder contract. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. 

This guideline is solely for explaining correct procedure reporting and does not imply coverage and reimbursement.

DESCRIPTION

Hemorrhoids are cushions of blood vessels and supporting tissue that form part of the normal anatomy of the rectum. Hemorrhoidal disease occurs when pressure increases within the vessels, causing these cushions to enlarge, become painful, and sometimes bleed upon defecation. 

This condition affects approximately 5% of the general population, with up to 50% of people over the age of 50 years having symptoms at some time. Internal hemorrhoids lie within the anal canal and are classified as:

• Grade I: Hemorrhoids that have bleeding only

• Grade II: Hemorrhoids that protrude or prolapse outside the anus upon defecation but withdraw spontaneously

• Grade III: Hemorrhoids that protrude and then must be pushed back inside

• Grade IV: Hemorrhoids that are permanently protruded
Transanal hemorrhoidal dearterialization (THD) is an interventional procedure for patients with symptomatic internal hemorrhoids. 

THD involves using a specially designed proctoscope combined with a Doppler transducer to locate the arterial branches associated with the hemorrhoids and to tie off the arteries with sutures in order 

To decrease blood flow. The purpose of the procedure is to shrink hemorrhoidal tissue and reduce symptoms.


Evidence to date demonstrates that THD is safe and resolves symptoms of grade II through IV hemorrhoids in the majority of patients. Symptom resolution was comparable for THD and hemorrhoidectomy, but postoperative pain, analgesia use, and complications were consistently lower for THD. 

Results were inconsistent for postoperative outcomes for THD and stapled hemorrhoidopexy, but recurrence may be higher for THD. 

There was a small amount of conflicting evidence regarding THD 
compared with ligation. There was insufficient evidence to compare THD with ligation.

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