Summary & Overview
CPT 46257: Excision of Hemorrhoid Group with Anal Fissure Removal
CPT code 46257 covers a combined anorectal surgical procedure: excision of a single internal and external hemorrhoid group plus removal of an anal fissure. This code captures a targeted operative approach for patients presenting with both symptomatic hemorrhoids and a fissure, and it is relevant for tracking utilization of minor anorectal surgeries nationwide. The code matters because it bundles two related procedures under one descriptor, affecting coding clarity, billing workflows, and payer review for surgical claims. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, guidance on typical settings of care, and an overview of common modifiers used with surgical CPT coding. The publication also summarizes benchmarking considerations, potential reimbursement implications from bundling procedures, and points of attention for claim documentation and medical necessity review. This national-level summary is intended for billing managers, surgical providers, and payer policy analysts seeking a clear understanding of what CPT code 46257 denotes and the administrative issues commonly associated with combined anorectal surgery coding.
Billing Code Overview
CPT code 46257 describes a surgical procedure in which the provider excises a single internal and external hemorrhoid group and removes an anal fissure (an open sore of the lower rectum). This service represents combined anorectal surgery addressing both hemorrhoidal disease and a concomitant fissure.
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Service type: Surgical excision of hemorrhoidal tissue with fissure removal
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Typical site of service: Ambulatory surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 45-year-old adult presents to an outpatient surgical clinic with persistent symptomatic hemorrhoidal disease and a chronic posterior anal fissure. Symptoms include bright red rectal bleeding with bowel movements, perianal pain, and discomfort refractory to conservative measures (fiber, topical agents, stool softeners). Examination under anesthesia confirms a single combined internal and external hemorrhoid group and a chronic fissure of the lower rectum. The surgeon schedules a single operative session to excise the symptomatic internal and external hemorrhoidal complex and to perform fissure excision/repair. The procedure is typically performed in an ambulatory surgery center or hospital outpatient department under regional or general anesthesia. Intraoperative workflow includes preoperative consent and time-out, anesthesia induction, anoscopic examination, excision of the hemorrhoidal tissue (internal and external components) and debridement/excision of the fissure, hemostasis, and local wound care. Postoperative recovery includes analgesia, instructions for stool softening, wound care, and a short-term follow-up visit to assess wound healing and symptom resolution.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default reporting when no specific modifier applies |
11 |