)

Anus

For a hemorrhoidectomy, the documentation should include the approach; whether the
hemorrhoid were internal, external, or both; and whether a fissurectomy and/or fi
tulectomy
were performed and whether more than one column/group was excised. When multiple
meth�
ods are used to remove multiple hemorrhoid , each procedure can be coded separately
using
modifier -51. The most common hemorrhoidectomy procedure performed in a physician's
office
is 46221, Hemorrhoidectomy, internal, by rubber band ligations. If a single
external hemorrhoid
column/group is exci ed, the coder is directed to use code 46999.

For codes 46270-46280, the following definitions apply:

� A subcutaneous fistulectomy does not involve the sphincter mu cleo

� A ubmuscular, or intersphincteric fistulectomy involves the division of the

sphincter
muscle.

Biliary Tract

A cholecystectomy can be performed either laparoscopically (47562-47564) or by open

approach (47600-47620). When it is tarted via a laparoscope and then converted to

an open
procedure, the procedure should be thoroughly documented. CPT Assistant (March
2000)
states that the open procedure should be reported with the attempted laparoscopic
procedure
and the appropriate modifier. Performance of an intraoperative cholangiogram and/or
explora�
tion of the common bile duct al 0 affect code assignment. Figure 4.20 displays the
differences
between the open and laparoscopic cholecystectomy procedures.