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Official Description

Excision of multiple external papillae or tags, anus

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 46230 involves the excision of multiple external papillae or tags located at the anus. Anal tags are defined as flaps of skin that appear at the anal verge, which is the area where the mucous membrane of the anal canal transitions to the perianal skin. These tags can often be associated with external hemorrhoids that have resolved, leading to the formation of a tag. Additionally, anal papillae are normal anatomical projections found in the epithelium at the upper end of the anal canal. In certain cases, these papillae may become inflamed or enlarged, necessitating their removal. The procedure begins with a thorough cleansing of the area to ensure a sterile environment. Following this, the enlarged papillae or external hemorrhoid tags are excised, and if necessary, the mucous membrane is closed using sutures to promote proper healing and restore the integrity of the anal region.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The excision of multiple external papillae or tags at the anus is indicated for the following conditions:

  • Enlarged Anal Papillae These are normal projections that may become inflamed or enlarged, requiring surgical intervention for relief.
  • External Hemorrhoid Tags These tags often result from the resolution of external hemorrhoids and may cause discomfort or hygiene issues, prompting their removal.

2. Procedure

The procedure for excising multiple external papillae or tags at the anus involves several key steps:

  • Step 1: Preparation The area surrounding the anus is thoroughly cleansed to minimize the risk of infection and ensure a sterile environment for the procedure.
  • Step 2: Identification The surgeon identifies the enlarged anal papillae or external hemorrhoid tags that require excision, ensuring that the correct structures are targeted for removal.
  • Step 3: Excision Using appropriate surgical instruments, the identified papillae or tags are carefully excised. This step requires precision to avoid damaging surrounding tissues.
  • Step 4: Closure After the excision, the mucous membrane may be closed as needed with sutures to promote healing and restore the anatomical structure of the anal region.

3. Post-Procedure

Post-procedure care involves monitoring the surgical site for any signs of infection or complications. Patients are typically advised on proper hygiene practices to maintain cleanliness in the area. Pain management may be necessary, and patients should be informed about potential discomfort during the recovery period. Follow-up appointments may be scheduled to assess healing and address any concerns that may arise after the procedure.

Short Descr REMOVAL OF ANAL TAGS
Medium Descr EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS
Long Descr Excision of multiple external papillae or tags, anus
Status Code Active Code
Global Days 010 - Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P6C - Minor procedures - other (Medicare fee schedule)
MUE 1
CCS Clinical Classification 81 - Hemorrhoid procedures
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
PT Colorectal cancer screening test; converted to diagnostic test or other procedure
SG Ambulatory surgical center (asc) facility service
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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2010-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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