Monday, July 12, 2010

Revised Hemorrhoidectomy cpt Codes - 46221, 46250, 46945

Skip 46930 with Revised  Hemorrhoidectomy Codes

Make sure you’re not reporting destruction of internal hemorrhoids by thermal energy with internal hemorrhoidectomy procedures. Bundles 46930 (Destruction of internal hemorrhoid[s] by thermal energy [eg, infrared coagulation, cautery, radiofrequency]) with each of the following 2010 revised codes:

46221 — Hemorrhoidectomy, internal, by rubber band ligation(s) $ 260- $ 290

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

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

46250 - Hemorrhoidectomy, external, 2 or more columns/groups - Average fee amount $470 - $510

46260 - Hemorrhoidectomy, internal and external, 2 or more columns/groups - Average fee amount $470 - $510

46946 — … two or more hemorrhoid columns/groups

46500 — Injection of sclerosing solution, hemorrhoids

46257 — … with fissurectomy

46258 — … with fistulectomy, including fissurectomy, when performed.

Most of these bundles have a modifier indicator of “0,” which means you can never
report these two procedures together.


Slotted Anoscope Hemorrhoidectomy CPT Code

46250 Hemorrhoidectomy, external, 2 or more columns/groups- Fee amount-  $321 $478

46255 Hemorrhoidectomy, internal and external, single column/group; $360 $523

46257 Hemorrhoidectomy, internal and external, single column/group; with fissurectomy $430 N/A

46258 Hemorrhoidectomy, internal and external, single column/group; with fistulectomy, including fissurectomy, when performed 474 N/A

46260 Hemorrhoidectomy, internal and external, 2 or more columns/groups; $484 N/A

46261 Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy $534 N/A

46262 Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when performed 566 N/A


Exception: The bundling between 46930 and 46258 has a modifier indicator of “1,” which means that in certain clinical circumstances you can break the bundle by appending a modifier. “This appears to be the only exception where 46930 can be billed at the same time as another treatment,” “This would only apply when the ligation and destruction were performed on different hemorrhoids or different sessions on the same day.” You would append modifier 59 (Distinct procedural service) to 46930 to bill these procedures separately.

Example: Your gastroenterologist sees a patient with extensive hemorrhoids and treats one hemorrhoid column by excision with fistulectomy (46258) and, at another location, performs another destruction by laser surgery (46930). In this case, you can report both procedures with
modifier 59. Just be sure that you don’t use this modifier if your gastroenterologist does an excision and then uses a laser to control bleeding at the same site. You cannot separately bill the work to control the bleeding.


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.

Office Visit and E&M Coding:

• If you see the patient in the office for an initial visit, you can code and charge for the office visit as well as the banding procedure. It is recommended to use modifier 25 to indicate it is a separate service. If there is a secondary diagnosis associated with their visit (anal spasm, anal fissure, IBS, constipation, diarrhea, etc.) apply modifier 25 when submitting the claim.

• 99213 Level III Office Visit
• 99214 Level IV Office Visit


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

NCCI Language Edit - 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.


Coding

The following Current Procedural Terminology (CPT) codes may be used to report hemorrhoidal band ligation procedures:

45350  Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids)
(Do not report 45350 in conjunction with 45334 for the same lesion)
(Do not report 45350 in conjunction with 45330, 45349, 46221)
(Do not report 45350 more than once per session)

45398 Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)
(Do not report 45398 in conjunction with 45382 for the same lesion)
(Do not report 45398 in conjunction with 45378, 45390, 46221)
(Do not report 45398 more than once per session)

46221 Hemorrhoidectomy, internal, by rubber band ligation(s)
(Do not report 46221 in conjunction with 45350, 45398)


Hemorrhoid banding is a procedure that involves placing a tight band around the hemorrhoid to cut off the blood supply. The information provided below is for one visit, but this procedure typically requires more than one visit to complete.

Billing

Listed below are the specific billing codes and fees associated with hemorrhoid banding. If the provider determines during your appointment that banding is not required, one of the appropriate office visit codes will be billed as shown below.

The actual allowed amount (the amount of the billed charge deemed payable by an insurance plan) for each charge and the amount of your out-of-pocket expenses will depend on your particular insurance plan. It is important to check your individual policy and direct any questions to your insurer to determine coverage and your financial responsibility prior to receiving treatment.

Billing Code

(CPT Code)                 Description           Charge Amount

46221 Hemorrhoidectomy $844

99213 Level III Office Visit $214

99214 Level IV Office Visit $316


Billing/Coding/Physician Documentation Information

This policy may apply to the following codes. Inclusion of a code in this section does not guarantee that it will be reimbursed. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross Blue Shield of North Carolina web site at www.bcbsnc.com. They are listed in the Category Search on the Medical Policy search page.

Applicable codes: 46505, 52287, 64611, 64612, 64615, 64616, 64617, 64642, 64643, 64644, 64645, 64646, 64647, 64653, 67345, 95873, 95874, J0585, J0586, J0587, J0588, S2340, S2341 BCBSNC may request medical records for determination of medical necessity. When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included.  Botulinum Toxin

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