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2025 CPT code 46262

Hemorrhoidectomy, internal and external, involving two or more columns/groups; with fistulectomy, and fissurectomy when performed.

Refer to the CPT guidelines for hemorrhoid surgery.Accurate documentation of the number of hemorrhoid groups, presence of a fistula, and fissure are crucial for appropriate code selection.

Modifiers may be applicable depending on the circumstances of the procedure. Consult the CPT manual and local payer guidelines for appropriate modifier use.

Medical necessity is established when the patient experiences significant symptoms such as pain, bleeding, and prolapse of hemorrhoids that significantly impact their quality of life and have not responded to conservative treatment options.The presence of a fistula and fissure further supports the medical necessity.

The surgeon prepares and anesthetizes the patient, locates the hemorrhoids, retracts the anal canal, incises the mucosa, separates the hemorrhoids, removes them, incises and excises the fistula, excises the fissure (if present), irrigates the area with antibiotics, and closes incisions with sutures or leaves the wounds open.

IMPORTANT:Do not report 46250-46262 in conjunction with 46948. For ligation of internal hemorrhoid(s), see 46221, 46945, 46946. For excision of internal and/or external hemorrhoid(s), see 46250-46262, 46320. For injection of hemorrhoid(s), use 46500. For destruction of internal hemorrhoid(s) by thermal energy, use 46930. For destruction of hemorrhoid(s) by cryosurgery, use 46999. For transanal hemorrhoidal dearterialization, including ultrasound guidance, with mucopexy, when performed, use 46948. For hemorrhoidopexy, use 46947. Do not report 46600 in conjunction with 46020-46947, 0184T, during the same operative session.

In simple words: This surgery removes two or more clusters of internal and external hemorrhoids.It also repairs an abnormal passage (fistula) and may remove a tear or sore (fissure) in the lower rectum.

This procedure involves the excision of two or more columns or groups of internal and external hemorrhoids.Additionally, it includes fistulectomy and, when present, fissurectomy. The surgeon accesses the hemorrhoids by retracting the anal canal, incises the mucosa around the hemorrhoid columns, separates the hemorrhoids from surrounding tissues, and removes them through the anal canal.The fistula is incised and the diseased tissue excised.The fissure, if present, is also excised.Post-operative irrigation with antibiotics and closure of incisions with sutures, or leaving wounds open for healing, are included.

Example 1: A 55-year-old male presents with multiple large internal and external hemorrhoids, a fistula, and a fissure. The surgeon performs a hemorrhoidectomy, fistulectomy, and fissurectomy., A 40-year-old female with significant bleeding from multiple internal and external hemorrhoids, a fistula, and a fissure undergoes a hemorrhoidectomy, fistulectomy, and fissurectomy., A 60-year-old male with chronic constipation and painful defecation due to multiple large internal and external hemorrhoids, fistula, and a fissure undergoes a hemorrhoidectomy, fistulectomy and fissurectomy.

Preoperative assessment including history and physical examination,intraoperative findings documenting the number of hemorrhoid columns/groups excised, presence and extent of fistula and fissure, surgical technique, and post-operative care.

  • Revenue Code: P5E
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:General Surgery, Colorectal Surgery
  • Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital
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