Hemorrhoids, whether internal or external, can be a real pain, and sometimes the best solution is a hemorrhoidectomy – surgery to remove them.
When it comes to billing for this type of procedure, accurate CPT coding is essential. Using the correct CPT code hemorrhoidectomy ensures that healthcare providers receive proper reimbursement for their services.
In this article, we’ll break down the different types of hemorrhoidectomies and the corresponding CPT codes you need to know for accurate billing and compliance.
Hemorrhoids and when they might require surgery
Hemorrhoids are swollen veins in your anus and rectum. Internal hemorrhoids start inside the rectum, while external hemorrhoids are located under the skin around the anus.
Hemorrhoids can be painful and itchy, and they may bleed. Sometimes they prolapse, meaning they bulge outside the anus.
A hemorrhoidectomy, or surgical removal of hemorrhoids, may be recommended when:
- Pain and discomfort persist
- Bleeding is chronic
- Hemorrhoids prolapse and don’t respond to other treatments
- Nonsurgical treatments haven’t worked
- External hemorrhoids have thrombosed (formed a blood clot)
Hemorrhoidectomy Procedures: An Overview
There are several different ways to perform a hemorrhoidectomy.
Traditional Excisional Hemorrhoidectomy
In a traditional excisional hemorrhoidectomy, the surgeon makes small incisions to cut away the hemorrhoidal tissue. This surgery may be performed under local, spinal, or general anesthesia.
Hemorrhoidectomy by Ligation
In this procedure, the surgeon cuts off the blood supply to the hemorrhoid, causing it to shrink. Ligation refers to the action of closing off the flow of blood to a particular location in the body. There are several different techniques and tools that can be used to ligate hemorrhoids, including a device called the Hemwell device.
Other Hemorrhoidectomy Techniques
There are other techniques that can be used to treat hemorrhoids. One such procedure is a stapled hemorrhoidopexy.
CPT Code 46945: Hemorrhoidectomy, Internal, by Non-Thermal Ligation
CPT code 46945 refers to “hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group.” This is a specific procedure involving the removal of internal hemorrhoids using a ligation technique that doesn’t involve rubber bands.
It’s important to understand the nuances of CPT codes to choose the correct one for billing purposes. CPT 46945 is distinct from other hemorrhoidectomy codes, which may describe different surgical techniques or apply to external hemorrhoids.
Appropriate Use Cases
When using the Hemwell device for internal hemorrhoidectomy via non-thermal ligation, CPT code 46945 is generally the correct choice. Note that the delivery method of ligation (suture, clipping, etc.) is not what determines the CPT code.
The key factor is that the ligation is achieved using a non-thermal method.
Why Other Codes May Not Apply
Codes like 46930 (hemorrhoidectomy, by rubber band ligation), 46250 (hemorrhoidectomy, external, complete), and 46999 (unlisted procedure, anorectum) are typically not appropriate for procedures using the Hemwell device. This is because they describe different procedures or are too general.
Coding Considerations and Documentation
When billing for a hemorrhoidectomy, be sure to provide detailed documentation in the patient’s medical record. The operative notes should clearly describe exactly what was done during the procedure. This will support the use of CPT code 46945.
Depending on the circumstances, you may also need to include additional codes. For example:
- 45330 – If performed with a sigmoidoscopy.
- 45378 – If performed with a colonoscopy.
Remember that the method used to perform the hemorrhoidectomy is not the main factor in choosing a CPT code.
To conclude
When coding for a hemorrhoidectomy, it’s essential to choose the right CPT code. The most common code is 46945, but selecting the right code for the procedure performed is critical to ensure proper reimbursement.
Make sure you stay up-to-date on the latest CPT coding guidelines to avoid claim denials.