CPT 46255 Hemorrhoidectomy Reimbursement | OpenPayer

Summary & Overview

CPT 46255: Excision of Single Internal and External Hemorrhoid

CPT code 46255 represents the surgical excision of a single internal and external hemorrhoid or hemorrhoid group. As a defined procedural code for hemorrhoidectomy, it is used nationally to document and bill for combined internal/external hemorrhoidal excision performed in ambulatory surgical centers, hospital outpatient departments, or operating rooms. Correct use of the code ensures appropriate clinical documentation and supports consistent payment and quality measurement for anorectal surgical care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, common utilization settings, and benchmarking context for payer coverage and claim adjudication practices where available. The publication outlines typical clinical indications for the procedure, expected sites of service, and the role of 46255 within surgical treatment options for hemorrhoidal disease.

This summary equips clinicians, billing staff, and policy analysts with a national-level reference for the code’s clinical meaning, payer landscape, and areas where documentation and coding precision matter. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare46255CPThemorrhoidectomysurgeryanorectalambulatory-surgeryoutpatientprocedure-coding

Billing Code Overview

CPT code 46255 describes a surgical procedure in which a provider excises a single internal and external hemorrhoid or hemorrhoid group. This procedure is a surgical hemorrhoidectomy targeting combined internal and external hemorrhoidal tissue.

Service type: Surgical excision of hemorrhoidal tissue
Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in a procedure room or operating room depending on patient and facility requirements

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45-year-old adult presenting to a colorectal or general surgery clinic with symptomatic hemorrhoidal disease unresponsive to conservative measures (fiber, topical agents, sitz baths). The patient reports persistent bleeding with bowel movements, pain with prolapsing internal hemorrhoids, and intermittent mucous discharge. After clinical examination including an anoscopy confirming one grouped internal and external hemorrhoid complex requiring excision, the surgeon schedules an operative procedure.

The procedure is performed in an ambulatory surgery center or hospital outpatient department under local anesthesia with sedation or monitored anesthesia care, or under general anesthesia for patient comfort or complexity. Preoperative documentation includes focused history and physical, informed consent describing risks (bleeding, infection, urinary retention), relevant medication reconciliation (anticoagulants), and pre-op anesthesia evaluation. Intraoperative documentation details the excision of a single internal and external hemorrhoid or hemorrhoid group, technique (e.g., combined excision and ligation), estimated blood loss, and any intraoperative complications. Postoperative instructions include pain control, wound care, stool softeners, and follow-up for wound check and possible pathology results if tissue was sent.

Typical workflow: referral from primary care or gastroenterology → pre-op assessment and consent → procedure scheduled at ambulatory surgery center or hospital outpatient department → intraoperative hemorrhoid excision using CPT 46255 → recovery and discharge with postoperative instructions and follow-up.

Coding Specifications

Modifier	Description	When to Use

CPT 46258: Excision of Hemorrhoid Group with Fistula and Fissure

CPT-46221-HEMORRHOID-RUBBER-BAND-LIGATION

CPT 46221: Rubber Band Ligation of Internal Hemorrhoid

CPT-46270-INCISION-EXCISION-FISTULA-TRACT

CPT 46270: Incision and Excision/Incision of Fistula Tract

CPT-46220-EXCISION-EXTERNAL-ANAL-PAPILLA-SKIN-TAG

CPT 46220: Excision of External Anal Papilla (Skin Tag)

CPT-46261-HEMORRHOIDECTOMY-MULTIPLE-HEMORRHOIDS-WITH-FISSURE-REMOVAL

CPT 46261: Excision of Multiple Hemorrhoids with Fissure Removal

CPT-46285-STAGED-FISTULA-REPAIR-SECOND-STAGE

CPT 46285: Staged Fistula Repair, Second-Stage Procedure

CPT-46280-COMPLEX-ANORECTAL-FISTULA-SURGERY-SETON-PLACEMENT

CPT 46280: Complex Anorectal Fistula Surgery, Possible Seton Placement

CPT-46200-ANAL-FISSURE-EXCISION-SPHINCTEROTOMY

CPT 46200: Excision of Anal Fissure with Possible Sphincterotomy

CPT-46250-EXCISION-TWO-OR-MORE-EXTERNAL-HEMORRHOIDS

CPT 46250: Excision of Two or More External Hemorrhoids

CPT-46262-HEMORRHOID-EXCISION-WITH-FISTULA-FISSURE-REMOVAL

CPT 46262: Excision of Multiple Hemorrhoids; Possible Fistula/Fissure Removal

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Taxonomy Code	Specialty	Notes
2080S0001X	Colorectal Surgery	Colorectal surgeons commonly perform excisional hemorrhoid procedures.
2080P0206X	General Surgery	General surgeons frequently perform this procedure in outpatient settings.
207RH0000X	Family Medicine	Family medicine with procedural training may perform minor anorectal excisions in some settings.
207L00000X	Gastroenterology	Gastroenterologists may diagnose and refer; some with surgical privileges perform anorectal procedures.
2080A0400X	Colon & Rectal Surgery	Colon and rectal specialists provide definitive surgical management for complex hemorrhoidal disease.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K64.0`	First degree hemorrhoids	Represents internal hemorrhoidal disease potentially treated with excision if symptomatic.
`K64.1`	Second degree hemorrhoids	Common indication for procedural interventions when conservative care fails.
`K64.2`	Third degree hemorrhoids	Frequently requires surgical hemorrhoidectomy such as `CPT 46255` for prolapsing hemorrhoids.
`K64.3`	Fourth degree hemorrhoids	Advanced disease that may require more extensive surgical management; relevant to operative planning.
`K64.8`	Other hemorrhoids	Captures atypical hemorrhoidal presentations where excision may be indicated.
`K64.9`	Hemorrhoids, unspecified	Used when laterality or degree is not specified but procedure is performed for symptomatic hemorrhoids.
`I84.0`	Hemorrhoids (obsolete grouping - historical coding)	Included here for clinical context where older documentation may reference hemorrhage-related codes; modern coding uses `K64` series.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46010`	Incision and drainage of perirectal or perianal abscess; simple or single	May be performed prior to or instead of hemorrhoid excision if abscess is present; addresses acute infection.
`46221`	Hemorrhoidectomy, internal, by rubber band ligation; simple, single	Non-excisional office-based treatment option for internal hemorrhoids; may be performed earlier in treatment algorithm.
`46255`	Hemorrhoidectomy, internal and external, single group (provided above)	Primary procedure that excises a single internal and external hemorrhoid or hemorrhoid group.
`46945`	Excision of lesion of anus; simple	May be reported for small perianal lesions or skin tags excised in the same operative session.
`99024`	Postoperative follow-up visit global period; minor surgical procedures	Used for routine postoperative visits during the global period when billed separately by some payors for documentation of care.

`11`	Office or other outpatient visit, aftercare	Use when reporting a standard, properly documented procedure in the usual manner (some payors use for professional component billing contexts).
`22`	Increased procedural services	Use when documentation supports substantially greater work than typical for `CPT 46255` (rare for this minor procedure).
`23`	Unusual anesthesia	Use when the procedure is performed under general anesthesia for medical necessity instead of usual local/regional.
`26`	Professional component	Use if facility bills technical component separately and the physician bills only professional component (rare for this procedure).
`50`	Bilateral procedure	Use if identical procedures are performed bilaterally and payor allows modifier for bilateral reporting.
`51`	Multiple procedures	Use when `CPT 46255` is billed with other distinct procedures during the same operative session.
`52`	Reduced services	Use if the procedure was started but not completed or performed in a reduced manner.
`53`	Discontinued procedure	Use when procedure is terminated due to extenuating circumstances after anesthesia induction.
`58`	Staged or related procedure or service by same physician during postoperative period	Use when `CPT 46255` is planned as part of staged treatment performed during the global period.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure from other services performed on the same day when bundling edits might apply.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`66`	Surgical team	Use when a team approach is medically necessary and documented.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Use for complications necessitating return to the OR related to the original hemorrhoid excision.

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