Summary & Overview
CPT 46260: Excision of Two or More Internal and External Hemorrhoids
CPT code 46260 represents a surgical hemorrhoidectomy for excision of two or more internal and external hemorrhoids or hemorrhoid groups. This procedure is a common proctologic operation performed to treat symptomatic, refractory, or complicated hemorrhoids. Nationally, accurate use of CPT code 46260 matters for appropriate surgical classification, care tracking, and payment for hemorrhoid care across ambulatory surgery centers and hospital settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent and service context, payer coverage considerations, and typical sites of service. The publication highlights benchmarks for utilization and payment patterns, recent policy or coding guidance that may affect billing, and clinical context to support correct procedure selection and documentation.
The content is organized to help coding managers, billing staff, and clinical leaders understand where CPT code 46260 fits within hemorrhoid treatment coding, common billing pitfalls, and how payers commonly approach surgical hemorrhoidectomy claims. Data not available in the input will be noted explicitly where applicable.
Billing Code Overview
CPT code 46260 describes a surgical procedure in which the provider excises two or more internal and external hemorrhoids or hemorrhoid groups. The service is a surgical hemorrhoidectomy involving removal of multiple hemorrhoidal tissues.
-
Service type: Surgical excision of multiple hemorrhoids
-
Typical site of service: Ambulatory surgery center or hospital operating room (outpatient or inpatient setting depending on clinical need)
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents to the colorectal surgery clinic with a several-month history of symptomatic hemorrhoidal disease characterized by persistent rectal bleeding, prolapse, pain with defecation, and failed conservative measures (dietary modification, topical agents, and office-based rubber band ligation). Examination identifies multiple internal and external hemorrhoids involving several quadrants. The patient is scheduled for elective outpatient operative excision of two or more internal and external hemorrhoids or hemorrhoid groups (CPT 46260).
Preoperative workflow includes history and physical, review of anticoagulation status, informed consent specific to hemorrhoidectomy risks (bleeding, infection, urinary retention, anal stenosis), bowel regimen and perioperative antibiotics per facility protocol, and anesthesia assessment. Typical anesthesia is monitored anesthesia care or general endotracheal anesthesia depending on patient comorbidities and surgeon preference. The procedure is commonly performed in an ambulatory surgery center or hospital outpatient department with typical intraoperative steps: patient positioning (lithotomy or prone jackknife), local infiltration and/or regional block as indicated, excision of hemorrhoidal cushions, hemostasis, and packing or suturing as required. Postoperative care includes recovery room monitoring, pain management plan, stool softeners, wound care instructions, and follow-up in 1–2 weeks for wound assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|