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BETA v.3.0

2025 CPT code 46945

Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance.

Use this code only for internal hemorrhoids treated with ligation methods other than rubber band ligation.Ensure the documentation clearly states the method used and the number of hemorrhoid columns/groups treated. The addition of "without imaging guidance" in the code description clarifies that imaging guidance is not included and should be coded separately if performed.

Modifiers may be applicable to this code to indicate specific circumstances, such as increased procedural services (modifier 22) or multiple procedures (modifier 51).

Medical necessity for this procedure must be established through documentation of the patient's symptoms, such as bleeding, prolapse, pain, or other related complications that impact their quality of life.Conservative treatments should be attempted and documented before surgical intervention is considered.

The surgeon prepares the patient, administers anesthesia, and then performs the ligation of the internal hemorrhoid(s) using a method other than rubber bands.Several techniques may be used, such as suture ligation or sclerotherapy.

IMPORTANT:For ligation of 2 or more hemorrhoid columns/groups, use 46946. For transanal hemorrhoidal dearterialization, single hemorrhoid column/group, use 46999. For rubber band ligation, use 46221.

In simple words: This procedure involves removing a single cluster of internal hemorrhoids by tying them off using a technique other than rubber bands.This cuts off blood flow to the hemorrhoids, causing them to shrink. No imaging guidance is used during this procedure.

This code describes a procedure for removing internal hemorrhoids by tying them off (ligation) using a method other than a rubber band, focusing on a single hemorrhoid column/group.It does not include imaging guidance.

Example 1: A patient presents with a single, symptomatic internal hemorrhoid column. The surgeon decides to perform a ligation using a transfixion suture technique., A patient has a single internal hemorrhoid group that is causing discomfort and bleeding. The surgeon opts for sclerotherapy, injecting a sclerosing solution to shrink the hemorrhoid., A patient with a single internal hemorrhoid column undergoes infrared coagulation, where an infrared coagulator is used to cause the hemorrhoid to shrink.

Documentation should include the type of ligation performed, the number of hemorrhoid columns/groups treated, and confirmation that no imaging guidance was used. The patient's symptoms and the medical necessity for the procedure should also be documented.

  • Specialties:General Surgery, Colorectal Surgery, Proctology
  • Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department, Physician's Office
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