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The procedure described by CPT® Code 46500 involves the injection of a sclerosing solution to treat one or more hemorrhoids, a condition characterized by swollen veins in the lower rectum and anus. This treatment, commonly known as sclerotherapy, utilizes a chemical agent that induces inflammation in the hemorrhoidal tissue. The mechanism of action involves the sclerosing solution causing the walls of the affected veins to adhere to one another, effectively closing them off from the bloodstream. Over time, this leads to a reduction in the size of the hemorrhoid as the body gradually reabsorbs the treated mass. This minimally invasive procedure is typically performed in an outpatient setting and is aimed at alleviating symptoms associated with hemorrhoids, such as pain, bleeding, and discomfort, while promoting healing and resolution of the condition.
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The injection of sclerosing solution for hemorrhoids is indicated for patients experiencing symptoms related to hemorrhoidal disease. The following conditions may warrant this procedure:
The procedure for the injection of sclerosing solution involves several key steps to ensure effective treatment of the hemorrhoids. The following outlines the procedural steps:
Following the injection of the sclerosing solution, patients may experience some discomfort or mild pain at the injection site, which is typically manageable with over-the-counter pain relief. It is important for patients to follow any post-procedure care instructions provided by their healthcare provider, which may include recommendations for dietary modifications, increased fluid intake, and avoiding straining during bowel movements. Patients should also be advised to monitor for any unusual symptoms, such as excessive bleeding or signs of infection, and to report these to their healthcare provider promptly. The expected outcome is a gradual reduction in the size of the hemorrhoids as the body reabsorbs the treated tissue, leading to symptom relief over time.
| Short Descr | INJECTION INTO HEMORRHOID(S) | Medium Descr | INJECTION SCLEROSING SOLUTION HEMORRHOIDS | Long Descr | Injection of sclerosing solution, hemorrhoids | 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 | 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). | 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.) | SG | Ambulatory surgical center (asc) facility service | 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. | 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.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2020-01-01 | Note | AMA Guidelines removed. |
| Pre-1990 | Added | Code added. |
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