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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, pain, and irritation. 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 hemorrhoidal 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 securely grasped with forceps, and a ligature device, which is not a rubber band, is placed around the base of the hemorrhoid. This ligature is crucial for interrupting the blood supply to the hemorrhoid, effectively leading to its removal. To further ensure the success of the procedure, a second ligature is applied just below the first, providing an additional safeguard in case the first ligature fails. This procedure is specifically coded as CPT® 46946 when two or more hemorrhoid columns or groups are treated by ligation without the use of imaging guidance.
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Hemorrhoidectomy, specifically the procedure coded as CPT® 46946, is indicated for patients experiencing significant symptoms related to internal hemorrhoids. The following conditions may warrant this surgical intervention:
The procedure for a hemorrhoidectomy coded as CPT® 46946 involves several critical steps to ensure effective treatment of multiple internal hemorrhoids:
After the hemorrhoidectomy procedure coded as CPT® 46946, patients are typically monitored for any immediate complications. Post-procedure care may include instructions for pain management, which can involve over-the-counter analgesics or prescribed medications. Patients are advised to maintain a high-fiber diet and stay hydrated to promote regular bowel movements and prevent straining during recovery. Follow-up appointments may be scheduled to assess healing and address any concerns. It is important for patients to be aware of potential signs of complications, such as excessive bleeding or signs of infection, and to seek medical attention if these occur.
| Short Descr | INT HRHC LIG 2+HROID W/O IMG | Medium Descr | INT HRHC BY LIGATION 2+ HROID W/O IMG GDN | Long Descr | Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups, 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 | 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 |
| 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. | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | 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. | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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). | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | 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 | 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. |
| 2011-01-01 | Changed | Guideline information changed. |
| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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