The CPT codes for hemorrhoidectomy procedures are explained below. First we’ll explain what Hemorrhoidectomy procedures are. That will be followed by descriptions and billing guidelines for the CPT codes for hemorrhoidectomy. The proper use of modifiers and examples can be found at the bottom.
Hemorrhoidectomy is the procedure to remove external or internal hemorrhoids that may be severe or large.
It is the most successful surgery for treating hemorrhoids; however, many complications can occur. Hemorrhoids are swollen blood vessels in the lower rectum that need attention only when they become inflamed.
What is Hemorrhoidectomy?
Internal hemorrhoids are present inside the rectum. Usually, they can’t be visible, and sometimes they cause discomfort; however, while passing stool, they may irritate. In addition, there may be bleeding during bowel movements.
The hemorrhoidal disorder develops when the pressure inside the veins rises. It causes the cushions to grow, be uncomfortable and occasionally bleed while defecating.
External hemorrhoids are usually when one or more painful lumps appear beneath the skin around the anus; these are dilated blood veins that have swelled to protrusion.
Blood may clot inside the protruding blood artery, causing thrombosis, resulting in a hard lump that causes discomfort in certain situations.
Hemorrhoids categorize into four grades:
Grade I: Hemorrhoids with merely bleeding occur.
Grade II: Hemorrhoids that bulge out or rupture outside the anus after defecation usually withdraw.
Grade III: Hemorrhoids emerge, but the physician must pull them back.
Grade IV: Hemorrhoids are permanently swelled up and injured.
Hemorrhoid banding is a treatment in which a rubber band is wrapped around the base of the hemorrhoidal tissue, limiting blood flow. This surgery may take two or three sessions to resolve the patient’s hemorrhoids.
The coding of hemorrhoids depends on medical records stating the treatment method, the type of hemorrhoids, and several hemorrhoids treated.
Billing Guidelines and Reimbursement For CPT Codes For Hemorrhoidectomy
There is more than one CPT code for Hemorrhoidectomy. The CPT codes for Hemorrhoidectomy are CPT 46220, CPT 46230, CPT 46221, CPT 46250, CPT 46255, CPT 46257, CPT 46258, CPT 46260, CPT 46261, CPT 46262, CPT 46320, CPT 46930, CPT 46945, CPT 46946 & CPT 46083.
Descriptions, billing guidelines and reimbursement for the CPT codes for Hemorrhoidectomy can be found below.
CPT Code 46220
46220 CPT Code Description: The excision of single papillae (external) or tag, anus. CPT code 46220 is a resequenced code.
The patient does not need to return at fixed intervals for further ligation. If you are billing for an anoscope (CPT 46200), please be aware that this may consider bundled with the procedure. There is no other modifier to alter this.
CPT Code 46221
46221 CPT Code Description: Hemorrhoidectomy (internal) with the help of rubber band ligation(s). The physician may execute hemorrhoidectomy tying off (ligating) internal hemorrhoids.
The surgeon identifies internal hemorrhoids. A physician may use a rubber band to bind a hemorrhoid at its base. The hemorrhoid tissue is allowed to peel off naturally over time.
Because hemorrhoidectomy (CPT 46221) has a global duration of 10 days per banding surgery, note that the patient may return after two weeks for additional bandings if necessary.
Therefore, the coder should report CPT 46221 once for any hemorrhoids banding secession, irrespective of how many ligated.
CPT Code 46230
46230 CPT Code Description: The excision of multiple papillae (external) or tags, anus. The surgeon removes a single (CPT 46220) or several (CPT 46230) external anal papillae or skin tags.
First, the physician identifies the anal skin tag or papilla, which typically connects with the exterior margin of a fissure or fistula.
Next, the physician creates an incision around the skin tag or papilloma. The lesion is dissected and removed from the underlying sphincter muscle. Sutures seal the incision, which may be slightly open to drain.
CPT Code 46250
46250 CPT Code Description: Hemorrhoidectomy (external) for two or more columns/groups. The surgeon performs excision of external hemorrhoids.
The physician identifies the external hemorrhoids. They create incisions around the hemorrhoids, and the lesions are separated and removed from the underlying sphincter muscle. He uses sutures to seal the incisions.
CPT Code 46255
46255 CPT Code Description: Hemorrhoidectomy (internal and external) for a single column or group. The surgeon performs the excision of a single column or group of internal and external hemorrhoids.
First, the surgeon examines, locates the hemorrhoid column, and forms an incision in the rectal mucosa around the hemorrhoids.
Then, the lesions are dissected and removed from the underlying sphincter muscles. Sutures can seal the incisions.
CPT Code 46257
46257 CPT Code Description: Hemorrhoidectomy (internal and external) for a single column/ group with fistulectomy. The physician excises a single column or group of internal and external hemorrhoids and an accompanying fissure.
The physician thoroughly assesses the anal canal. And he locates the hemorrhoid column and fissure by forming an incision in the rectal mucosa around the hemorrhoids.
The lesions are separated and removed from the underlying sphincter muscles. Next, he may make an incision around the fissure. The aperture is dissected and removed from the underlying sphincter muscles. Finally, he may use sutures to seal the incisions.
CPT Code 46258
46258 CPT Code Description: Hemorrhoidectomy (internal and external) for a single column/ group with fistulectomy. First, the physician investigates the anal canal and locates the hemorrhoid column and fistula.
Suppose the fistula is in the same plane as the hemorrhoid. In that case, he makes a single incision in the mucosa around the lesions, dissects the lesions, and removes them from the underlying sphincter muscles.
If the lesions are on distinct planes, he may excise them using separate incisions. If a fissure is present, the provider can excise it in the same way. He may utilize sutures to seal the incisions.
CPT Code 46260
46260 CPT Code Description: Hemorrhoidectomy (internal and external) for two or more columns/groups. The physician excises two or more columns or clusters of internal and external hemorrhoids.
First, the surgeon examines and locates the hemorrhoid columns. Then, he makes incisions around the hemorrhoid columns and dissects the lesions. Sutures can seal the incisions.
Suppose the method “anoscopy” with a bleeding control (CPT 46614) does not work. And it is followed by a problematic or extensive internal and external “hemorrhoidectomy” (CPT 46260).
In that case, the coder should document only CPT 46260. As a result, CPT 46614 cannot be reported independently from CPT 46260.
However, if the surgeon executes an anoscopy with a bleeding control (CPT 46614) in the same session. And it is immediately followed by an internal/external, complex hemorrhoidectomy described by CPT 46260 based on the endoscopic service findings.
CPT Code 46261
46261 CPT Code Description: Hemorrhoidectomy (internal and external) for two or more columns/groups with fistulectomy. The physician performs the excision of two or more columns or groups of internal and external hemorrhoids and a related fissure.
The surgeon locates hemorrhoids by examining the anal canal and accomplishes rectal mucosa incisions around the hemorrhoid columns and the aperture.
The lesions are separated and removed from the underlying sphincter muscles. And he seals the incision with the help of sutures.
CPT Code 46262
46262 CPT Code Description: Hemorrhoidectomy (internal and external) for two or more columns/groups with fistulectomy. The surgeon excises two or more columns or groups of internal and external hemorrhoids.
Next, he uncovers hemorrhoid columns and fistula by assessing the anal canal and makes some incisions in the rectal mucosa near hemorrhoid.
Next, the lesions are dissected and removed from the underlying sphincter muscles. If a fissure is present, he pulls it in the same way. Finally, to seal incisions, he may utilize sutures.
CPT Code 46320
46320 CPT Code Description: The excision of thrombosed hemorrhoid (external).The surgeon removes external hemorrhoid that has gotten clogged with blood (thrombosed).
The thrombosed external hemorrhoid exposes itself after a proper anesthetic agent. Then, he may use a scalpel to remove the hemorrhoid thoroughly. The excision site may be closed or left open to allow continuous drainage.
CPT Code 46930
46330 CPT Code Description: The destruction of internal hemorrhoid(s) with the help of thermal energy (e.g., infrared coagulation, cautery, radiofrequency). The physician may destroy internal hemorrhoids by utilizing various sorts of heat energy.
They can remove hemorrhoids by clamping and cauterization, radio-frequency (high-frequency radio waves), or infrared or laser coagulation.
Which causes the hemorrhoidal tissue to stiffen, degrade, and produce scar tissue as the region heals. It is possible to eliminate the hemorrhoidal remains.
CPT Code 46945
46945 CPT Code Description: Hemorrhoidectomy (internal), by ligation other than rubber band for a single hemorrhoid column/group.
CPT Code 46946
46946 CPT Code Description: Hemorrhoidectomy (internal), by ligation other than rubber band for two or more hemorrhoid columns/groups. Internal hemorrhoids are ligated (tied off) by the physician using different techniques other than rubber bands.
The surgeon examines the anal canal and locates the hemorrhoid column(s). The coder must report CPT 46945 for a single hemorrhoid column or group ligation.
Report CPT 46946 for two or more columns or groups ligation. There is no use of imaging guidance.
CPT Code 46083
46083 CPT Code Description: The incision of thrombosed hemorrhoid (external).
The physician incises a thrombosed external hemorrhoid and extracts the thrombus by an incision in the skin over the hemorrhoid. He leaves the incision open to allow for more drainage.
CPT Code 46999
The coder or biller should report the following by using CPT 46999 (Unlisted procedure, anus):
- Cryosurgery is helpful to destroy hemorrhoids
- External hemorrhoidectomy, single column/group
- Hemorrhoid(s) destruction utilizing a method not presently indicated by a CPT code
One may record only one HCPCS/CPT code reflecting the most intensive procedure if the physician uses numerous services to treat hemorrhoids at the same patient encounter.
For example, suppose he drains an abscess during hemorrhoids treatment. In that case, the incision and drainage are not independently reportable.
Modifiers For CPT Code For Hemorrhoidectomy
The following are modifiers commonly used for a CPT code for hemorrhoidectomy.
Use modifier 22 when the procedure takes longer than standard procedural services.
Use modifier 51 when the physician accomplishes multiple operations at a time.
Use modifier 52 when due to some circumstance’s method is partially reduced.
Use modifier 53 when a surgical or diagnostic procedure discontinues after starting the process due to some circumstance.
Use modifier 58 when the physician performs a procedure during the global period; it may be a staged procedure or service by the same physician or other qualified health care professional during the postoperative period.
Use Modifier 59 when other distinct procedural services are there other than E/M.
Use modifier 78 when a patient has an unplanned return to the operating/procedure room by the same physician following the initial procedure for a related process during the postoperative period.
Use Modifier 79 when the same physician or other qualified healthcare professional performs an unrelated procedure or service during the postoperative period.
CPT Code For Hemorrhoidectomy Example
A 54 years old male patient suffering from severe pain and swelling came at the appointed time. The perianal abscess is identified, incised, and drained during an internal and external hemorrhoidectomy.
The coder may use CPT 46255, 46050-51. CPT’s description states that “Hemorrhoidectomy, internal and external, single column/group” and incision and drainage.
The physician performs a perianal abscess; therefore, the coder must use CPT 46050 and modifier 51 because he performed multiple procedures at a time.