![]() ![]() These terms refer to swelling of an anorectal vein in a single location that results in a “cluster-like” or “pillar” appearance that is known as a group/column of hemorrhoids. You will see the words “group” or “column” listed quite frequently in CPT codes for hemorrhoid procedures. Question #2: How many hemorrhoids are being treated? If the surgeon fails to provide any of these details to confirm internal vs external hemorrhoids, reach out to the surgeon to obtain additional information before coding. So if you see those quadrants or “clock positions” mentioned in your operative report you can be confident you are looking at an internal hemorrhoid. Sometimes, though, a surgeon won’t say the word “internal” but instead will list the location of the hemorrhoids in terms of “quadrants.” You may see notations such as “right posterior,” “right anterior,” and “left lateral.” The CPT manual states that an anal column is considered to be an internal hemorrhoid in 3 major areas of the anal canal: the right posterior (or 1 o’clock position) right anterior (or 5 o’clock position) or the left lateral (or 9 o’clock position). This detail affects not only our CPT code for the procedure, but our ICD-10-CM code for the diagnosis as well. Most surgeons that I have worked for are aware of the importance of documenting whether the hemorrhoids they are treating are internal, external, or both (i.e., mixed). You may also see a surgeon use the term mixed hemorrhoid which is one that begins above the dentate line and continues below it (i.e., it has an internal and external component). External hemorrhoids based on their location are often visible externally and can be felt when examining the area. An external hemorrhoid is one that is located below the dentate line. Internal hemorrhoids are often located further up in the lower rectum where they cannot be felt during an exam. The dentate line is also sometimes called the pectinate line or the anorectal junction so if you see any of these terms in an operative report and the hemorrhoids are located above this line, rest assured these terms all mean the same thing, and you know the hemorrhoid is internal. An internal hemorrhoid is one that is above the dentate line (i.e., above the line that divides the upper two thirds from the lower third of the anal canal). When you look at codes for hemorrhoid treatment in CPT, you will see the words “internal” and “external” used a lot in the code descriptions. ![]() Question #1: Where are the hemorrhoids located? I find it helpful to ask myself the questions below when coding hemorrhoid procedures to identify all of these important details. In addition to identifying “how” the hemorrhoid was treated, you also need to know additional details including where the hemorrhoids are located, how many hemorrhoids (e.g., groups/columns) are treated, and whether there are specific complications associated with the hemorrhoids (e.g., prolapse, thrombosis). Destruction: Destruction means using some kind of thermal energy such as electrocautery, laser, or infrared to apply heat to and destroy the hemorrhoid tissue.Stapling: Stapling as the name implies involves placing staples that separate hemorrhoid tissues from the rest of the rectal wall while a knife is used to excise the hemorrhoids.Ligation: Ligation means to tie off/cut off blood supply.Excision: Excision means to cut out/remove.It is helpful to understand what each of these terms means so you know if you are picking a CPT code that accurately describes the procedure you are trying to code. Hemorrhoids can be treated by many different methods including excision, ligation, stapling, and destruction. So it is no surprise that if you code for a general surgeon, you will probably code a lot of procedures designed to treat hemorrhoids. It is estimated that at least 50% of adults will develop hemorrhoids at some point in their lives. Hemorrhoids are swollen veins located in the anus or the lower rectum.
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