How To Use CPT Code 46261

CPT 46261 describes the excision of two or more internal and external hemorrhoids or hemorrhoid groups, along with a fissurectomy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 46261?

CPT 46261 can be used to describe the excision of two or more internal and external hemorrhoids or hemorrhoid groups, along with a fissurectomy. This code is used when the provider removes the hemorrhoids and the open sore in the lower rectum, known as a fissure, during the same procedure.

2. Official Description

The official description of CPT code 46261 is: ‘Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. The provider locates the external hemorrhoids near the anal canal and the internal hemorrhoids inside the anus.
3. The provider incises the mucosa around the hemorrhoid column and separates the hemorrhoid from surrounding tissues.
4. The provider removes the hemorrhoid through the anal canal.
5. The provider incises around the fissure and excises the diseased area.
6. The provider irrigates the operative sites with antibiotics and closes the incisions with sutures or leaves the wounds open for self-healing.

4. Qualifying circumstances

Patients eligible to receive CPT 46261 services are those with two or more internal and external hemorrhoids or hemorrhoid groups, along with a fissure that requires excision. The procedure must be performed by a qualified provider who is trained in performing hemorrhoidectomies and fissurectomies.

5. When to use CPT code 46261

CPT code 46261 should be used when the provider performs the excision of two or more internal and external hemorrhoids or hemorrhoid groups, along with a fissurectomy, during the same procedure. This code should not be used for other types of hemorrhoidectomies or fissurectomies.

6. Documentation requirements

To support a claim for CPT 46261, the provider must document the following information:

• Patient’s diagnosis and the need for excision of hemorrhoids and fissure
• Details of the procedure, including the number of hemorrhoids or hemorrhoid groups excised and the extent of the fissurectomy
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 46261, ensure that the procedure meets the criteria for excision of two or more internal and external hemorrhoids or hemorrhoid groups, along with a fissurectomy. Do not report CPT 46261 if the procedure does not meet these criteria. It is important to follow the specific documentation requirements and guidelines provided by the payer to ensure accurate and timely reimbursement.

8. Historical information

CPT 46261 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2010, the code description was changed to include complex or extensive hemorrhoidectomies.

9. Examples

1. A provider performs the excision of three internal and external hemorrhoids, along with a fissurectomy, during a single procedure.
2. A patient undergoes the excision of two internal and external hemorrhoid groups, along with a fissurectomy, to alleviate symptoms and improve their quality of life.
3. A provider performs the excision of four internal and external hemorrhoids, along with a fissurectomy, to address the patient’s chronic pain and discomfort.
4. A patient with recurrent hemorrhoids and a fissure undergoes the excision of three internal and external hemorrhoids, along with a fissurectomy, to prevent further complications.
5. A provider performs the excision of two internal and external hemorrhoid groups, along with a fissurectomy, to treat the patient’s bleeding and discomfort.
6. A patient undergoes the excision of three internal and external hemorrhoids, along with a fissurectomy, to improve their overall anal health and well-being.
7. A provider performs the excision of two internal and external hemorrhoid groups, along with a fissurectomy, to alleviate the patient’s pain and improve their quality of life.
8. A patient with multiple hemorrhoids and a fissure undergoes the excision of four internal and external hemorrhoids, along with a fissurectomy, to prevent further complications and improve their anal health.
9. A provider performs the excision of three internal and external hemorrhoids, along with a fissurectomy, to address the patient’s chronic bleeding and discomfort.
10. A patient undergoes the excision of two internal and external hemorrhoid groups, along with a fissurectomy, to relieve their symptoms and improve their overall anal health.