Q. Can offices be reimbursed if hemorrhoids in different quadrants are treated within the 90-day global period?

A. Yes, the second hemorrhoid would be considered a staged/related procedure during the post-op period and modifier 58 would have to be attached to 46934 in the post-op period. Full reimbursement should be attained provided that there is at least 2 weeks between each procedure. Several states have written Local Coverage Decisions per Medicare for IRC of hemorrhoids.

Q. If anal warts are present, can they be treated and billed separately, if performed at the same time as the hemorrhoids?

A. Anal warts (46924) and internal hemorrhoids are not bundled and should be separately reimbursed. Of course, this is per Correct Coding Initiative Guidelines. There are some private payors who utilize different guidelines.

Q. If the patient’s hemorrhoids have an external component, and the physician uses CPT code 46936 (Destruction of hemorrhoids - internal and external) for a subsequent visit, can they be treated within the 90 day period?

A. 46936 can be billed during the global with a modifier either 58 if preplanned or 79 if unplanned. It should also be fully reimbursed.

Q. Can the office visit and anoscopy be billed separately?

A. Anoscopy is considered part of the procedure and not separately billable. However, if flexible sigmoidoscopy or colonoscopy is done prior to the IRC, to rule out a bleeding source higher up, then both the endoscopy and IRC are billable and reimbursable. An office visit could also be billed with a 25 modifier provided that this is a visit on the day of an unplanned IRC. If the IRC had already been scheduled, then no visit can be billed unless for a completely different reason than the IRC.

Q. If the IRC hemorrhoid treatment is performed in an Ambulatory Surgical Center, will both the physician and facility be reimbursed?

A. The physician will be reimbursed no matter where the procedure is performed. However, when done in an ASC, the ASC will not be reimbursed by Medicare until policy changes. Private payors/PPOs, etc., are often willing to negotiate and pay the facilities for codes under contract negotiation. Physicians performing IRC hemorrhoid treatment usually purchase their own equipment and use it in their office setting.

^ISource: Kathleen Mueller, R.N., CPC, CCS-P, Coding consultant, Lenzburg, IL