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Excision of a thrombosed hemorrhoid, classified under CPT® Code 46320, refers to a surgical procedure aimed at removing an external hemorrhoid that has developed a blood clot, leading to significant discomfort and pain. External hemorrhoids are swollen blood vessels located outside the anal canal, and when they become thrombosed, they can cause severe tenderness, making activities such as sitting, walking, or passing stool quite challenging for the patient. The procedure begins with a thorough examination of the perianal tissue to assess the extent of hemorrhoidal disease, often utilizing an anoscope for better visualization. Prior to the excision, the perianal skin and anal canal are meticulously cleansed, and a local anesthetic is administered at the base of the hemorrhoid to ensure patient comfort during the procedure. To enhance visibility and access to the hemorrhoid, a clamp may be applied to the skin. The surgeon then makes a radial or circumferential incision over the thrombosed hemorrhoid to effectively remove the blood clots. The excision is performed using an elliptical incision that fully encompasses the external hemorrhoid. After the hemorrhoidal plexus and any clots are excised, the base of the wound is carefully examined for any remaining hemorrhoidal tissue or clots, which are also removed. To manage any bleeding that may occur during the procedure, techniques such as applying pressure or using electrocautery are employed. Finally, the surgical wound may either be sutured closed or left open to allow for natural healing, depending on the specific circumstances of the case.
© Copyright 2025 Coding Ahead. All rights reserved.
The excision of a thrombosed hemorrhoid is indicated for patients experiencing significant pain and discomfort due to the presence of a thrombosed external hemorrhoid. The following conditions may warrant this procedure:
The procedure for excising a thrombosed hemorrhoid involves several critical steps to ensure effective removal and patient safety. The following outlines the procedural steps:
Post-procedure care for patients who have undergone excision of a thrombosed hemorrhoid typically includes monitoring for any signs of complications such as excessive bleeding or infection. Patients are advised to manage pain with prescribed medications and to follow specific instructions regarding wound care. It is also important for patients to maintain a high-fiber diet and stay hydrated to facilitate bowel movements and prevent straining, which can exacerbate the condition. Follow-up appointments may be scheduled to assess healing and address any ongoing symptoms or concerns.
| Short Descr | REMOVAL OF HEMORRHOID CLOT | Medium Descr | EXC THROMBOSED HEMORRHOID XTRNL | Long Descr | Excision of thrombosed hemorrhoid, external | 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 | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 2 | CCS Clinical Classification | 81 - Hemorrhoid procedures |
| 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.) | 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | 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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