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General Surgery Coding Alert

You Be the Coder:
46211: Use for All Internal Ligations?

Question: Our surgeon performs internal hemorrhoid ligation using surgical thread. Should we code this as 46221, and can we use multiple units for multiple hemorrhoids?Texas SubscriberAnswer: No, you should not list the procedure as 46221 (Hemorrhoidectomy, internal, by rubber band ligation[s]). Instead, you should report 46945 (Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group).Here's why: Because your surgeon uses surgical thread instead of rubber bands, 46945 is the most specific code. You'll notice that the unit of service is different for the 46221 versus 46945. Because 46221 states, "ligation(s)," you should report only one unit of the code for a single surgical encounter, regardless of the number of internal hemorrhoids that the surgeon ligates using rubber bands.On the other hand, the unit of service for 46945 is the "single hemorrhoid column/group." But that still doesn't mean you should report multiple units of 46945 for multiple hemorrhoid groups.Instead: [...]