Internal & External Hemorrhoidectomy and CPT

Current Procedural Terminology (CPT) coding for medical billing depends on physician notes. Hemorrhoidectomy is a surgical procedure to remove hemorrhoids. The surgeon describes the location of the hemorrhoid and the method used to excise it in the "op notes," which are the procedure documentation.

Anatomy and Terminology

• Hemorrhoids occur in the anal area. The anal verge is the outer end of the anal canal. About a centimeter above the anal verge is a mucocutaneous junction called the dentate line or pectinate line, which separates the anus from the rectum. Internal hemorrhoids occur above the dentate line, and external occur below, toward the anal verge.

CPT Codes

• CPT refers to the Current Procedural Terminology codebook with rules and guidelines used for coding procedures for insurance claims in medical billing. Different codes exist depending on the location of the hemorrhoid, method of removal and if clotting is present in it. The Coding Institute notes that location takes precedence over the other considerations, such as whether the hemorrhoid is internal, external or both.

New CPT Guideline

• The CPT provides help and guidance through text notes in the related sections, often under the specific code entry. According to the Hemorrhoids Treatment website, a new text note in the 2010 CPT helps clarify which codes to use for external and/or internal hemorrhoids. The CPT text note reads, "For excision of internal and/or external hemorrhoids, look at 46250-46262, 46320." It's important to pay attention to the text notes.

Physician Notes

• For billing purposes, the surgeon must clearly document the location of the hemorrhoid that was treated. If the op notes are unclear, request details from the surgeon, advises The Coding Institute.