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Ligasure External hemorrhoidectomy and scalpel use

Tanesha Posted Thu 20th of September, 2018 00:20:44 AM
External and Internal hemorrhoids were treated. I coded 46945 for the internal hemorrhoids. Is this correct? What do I use for the external hemorrhoids treated with ligasure? Unlisted or is ligasure in the same category as 46260 as the physician doesn't see the difference? EXCERPT: With these 3 major internal groups dealt with, the attention was turned to the external ones. Here, some application of the LigaSure was performed, but most of the dissection was sharp using scalpel and scissors. The redundant overlying skin was debulked and the wounds were closed with running and interrupted 3-0 Vicryl sutures. Some additional smaller internal groups were also then removed with the LigaSure. Only the posterior quadrant was relatively spared.
Tanesha Posted Thu 20th of September, 2018 09:39:56 AM
Could you please provide any resources/articles regarding Ligasure hemorrhoidectomy coding? I can't find anything through the usual channels. I would like to relay the info to the physician if different from the traditional hemorrhoidectomy codes (46260). It seems this maybe traditional excision, just with a different tool, but not completely sure.
SuperCoder Answered Thu 20th of September, 2018 10:50:23 AM


If the surgeon excises both external and internal hemorrhoids during the same session, you shouldn't choose one of each code from the external and internal excision codes. As per the documentation provided, you should use 46260 (Hemorrhoidectomy, internal and external, complex or extensive). To support your coding claim, you must be sure that the physician's documentation justifies the selection of 46260 by noting the determining factors. 

Please feel free to ask, if you have any questions.


Tanesha Posted Thu 20th of September, 2018 23:47:46 PM
I understand to use 46260 if regular excisional internal and external hemorrhoidectomy, but he used LIGASURE. Is this the same as the ligation hemorrhoidectomy without rubber band or does this fall under 46260? I can't find anything that points me in one direction or another.
SuperCoder Answered Mon 24th of September, 2018 09:57:56 AM


Ligasure® vessel sealing system is a device used for the hemorrhoidectomy. There are no specific code for external hemorrhoidectomy with Ligasure. So, appropriate code as per the above documentation provided is 46260. 


Tanesha Posted Mon 24th of September, 2018 23:19:53 PM
Thank you
SuperCoder Answered Tue 25th of September, 2018 00:30:55 AM

Thank you, happy to help.

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