In simple words: This minimally invasive procedure uses ultrasound to locate and tie off the blood supply to swollen hemorrhoids.It may also involve repairing prolapsing tissue in the area.

This procedure involves using a special proctoscope with a Doppler probe and light source to identify and ligate hemorrhoidal arteries supplying the hemorrhoid columns or groups.The patient is positioned in the lithotomy or prone position and may receive general or local anesthesia. A gel lubricant is used before inserting the proctoscope. The Doppler identifies the arteries, which are then ligated with sutures. If prolapse is present, the excess mucosa is plicated. The procedure is performed on 2 or more hemorrhoid columns/groups.

Example 1: A patient presents with symptomatic internal hemorrhoids in two columns with associated mucosal prolapse. THD with mucopexy (46948) is performed., A patient has four columns of internal hemorrhoids treated with THD.Mucopexy is not necessary, so 46948 is reported., During a THD procedure on three hemorrhoidal columns, the surgeon encounters significant bleeding requiring more extensive intervention. Modifier 22 would be appended to 46948 to signify increased procedural services.

Documentation should include the number of hemorrhoid columns treated, presence or absence of prolapse, type of anesthesia, any complications, and confirmation of ultrasound guidance.