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Hemorrhoids are swollen blood vessels located in the anal region, which can lead to discomfort and various symptoms. Internal hemorrhoids specifically refer to those that develop inside the anal canal, often causing issues such as bleeding or pain during bowel movements. The evaluation of hemorrhoidal disease typically involves a thorough examination of the perianal tissue, which is conducted using specialized instruments like an anoscope or proctoscope. This examination helps determine the extent of the condition. Prior to the procedure, the perianal skin and anal canal are meticulously cleansed to minimize the risk of infection. A local anesthetic is then 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 utilized to provide traction to the surrounding skin. The hemorrhoid is then carefully grasped with forceps, and a ligation device, which is not a rubber band, is applied around the base of the hemorrhoid. This ligature is crucial as it interrupts the blood supply to the hemorrhoid, effectively treating the condition. A second ligature is placed just below the first to provide additional security, ensuring that the blood flow is sufficiently obstructed even if one ligature fails. The CPT® Code 46945 is specifically designated for the treatment of a single hemorrhoid column or group using this ligation method without the aid of imaging guidance. In contrast, for cases involving two or more hemorrhoid columns or groups, the appropriate code to use is 46946.
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Hemorrhoidectomy by ligation is indicated for patients experiencing symptoms related to internal hemorrhoids. The following conditions may warrant this procedure:
The procedure for performing a hemorrhoidectomy by ligation involves several critical steps to ensure effective treatment of the hemorrhoid. First, the physician conducts a thorough examination of the perianal area using an anoscope or proctoscope to assess the extent of the hemorrhoidal disease. Following this evaluation, the perianal skin and anal canal are cleansed meticulously to reduce the risk of infection. A local anesthetic is then injected at the base of the hemorrhoid to provide pain relief during the procedure. To facilitate better visibility and access, a clamp may be applied to the skin surrounding the hemorrhoid, allowing for improved exposure. Once the hemorrhoid is adequately exposed, the physician uses forceps to grasp the hemorrhoid securely. At this point, a ligation device, which is not a rubber band, is placed around the base of the hemorrhoid. This ligature is crucial as it interrupts the blood supply to the hemorrhoid, effectively treating the condition. To enhance the effectiveness of the ligation, a second ligature is applied just below the first, ensuring that blood flow is sufficiently obstructed even if one of the ligatures were to fail. This careful technique is essential for the successful treatment of a single hemorrhoid column or group.
After the hemorrhoidectomy by ligation, patients are typically monitored for any immediate complications. Post-procedure care may include instructions for pain management, which can involve over-the-counter analgesics. Patients are advised to maintain a high-fiber diet and stay hydrated to promote regular bowel movements and prevent straining, which can exacerbate discomfort. It is also important for patients to follow up with their healthcare provider to monitor healing and address any concerns that may arise during the recovery process. Patients should be informed about signs of complications, such as excessive bleeding or signs of infection, and instructed to seek medical attention if these occur.
| Short Descr | INT HRHC LIG 1 HROID W/O IMG | Medium Descr | INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN | Long Descr | Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance | Status Code | Active Code | Global Days | 090 - Major Surgery | 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 | Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; 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 |
| 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. | 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). | 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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| 2020-01-01 | Changed | Code description changed. |
| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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