CPT 46261 Hemorrhoidectomy Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 46261: Excision of Multiple Hemorrhoids with Fissure Removal

CPT code 46261 represents a combined anorectal surgical procedure: excision of two or more internal and external hemorrhoids or hemorrhoid groups with concurrent removal of an anal fissure. This code captures a distinct operative service used by colorectal and general surgeons when multiple hemorrhoidal groups and a fissure require surgical management. Nationally, accurate coding of complex anorectal procedures like 46261 affects clinical documentation, payer adjudication, and aggregate utilization measures for surgical specialties.

Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview, typical sites of service (ambulatory surgical centers and hospital outpatient/inpatient settings), and the contexts in which this code is used. Data not available in the input prevents presentation of payer-specific reimbursement benchmarks or utilization statistics.

This publication provides clarity on the clinical intent of 46261, common settings where the service is delivered, and what information is missing from the supplied dataset (for example, associated taxonomies, ICD-10 codes, and related billing lines). The goal is to help clinical, coding, and administrative audiences recognize when 46261 is the appropriate code to represent combined hemorrhoidectomy and fissure removal procedures and what supplemental data would be needed for comprehensive financial and compliance review.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 46261hemorrhoidectomyanal fissureanorectal surgerysurgical codingambulatory surgeryhospital outpatientprocedure codingsurgical billing

Billing Code Overview

CPT code 46261 describes a surgical procedure in which the provider excises two or more internal and external hemorrhoids or hemorrhoid groups and also removes an anal fissure (an open sore of the lower rectum). This procedure combines hemorrhoidectomy for multiple hemorrhoid groups with fissure removal.

Service type: Surgical procedure — anorectal surgery
Typical site of service: Ambulatory surgical center or hospital outpatient/inpatient surgical setting

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents to the ambulatory surgery center with symptomatic hemorrhoidal disease characterized by prolapsing internal hemorrhoids and painful external hemorrhoids, plus a chronic posterior anal fissure refractory to conservative care. After preoperative evaluation and informed consent, the patient undergoes general or monitored anesthesia care. The colorectal surgeon performs an excision of two or more internal and external hemorrhoids (hemorrhoid groups) and concurrently excises the chronic fissure. Intraoperative steps include lithotomy positioning, anoscopic visualization, identification of internal and external hemorrhoidal tissue, excision and ligation of hemorrhoidal bundles, and excision and primary management of the fissure. Hemostasis is obtained, and local anesthetic and wound care are applied. The patient is recovered in PACU and discharged with analgesics, stool softeners, and wound care instructions, with follow-up in clinic to assess healing and complications such as bleeding, infection, or anal stenosis.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	When a separate, distinct procedure or service is performed at a different anatomic site or session and needs to be distinguished from other procedures on the same date.
`52`

CPT 46258: Excision of Hemorrhoid Group with Fistula and Fissure

CPT-46230-ANAL-SKIN-TAG-EXCISION-MULTIPLE-EXTERNAL-PAPILLAE

CPT 46230: Excision of Multiple External Anal Papillae (Skin Tags)

CPT-46257-HEMORRHOID-EXCISION-WITH-ANAL-FISSURE-REMOVAL

CPT 46257: Excision of Hemorrhoid Group with Anal Fissure Removal

CPT-46200-ANAL-FISSURE-EXCISION-SPHINCTEROTOMY

CPT 46200: Excision of Anal Fissure with Possible Sphincterotomy

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

CPT 46285: Staged Fistula Repair, Second-Stage Procedure

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

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

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

CPT 46280: Complex Anorectal Fistula Surgery, Possible Seton Placement

CPT-46221-HEMORRHOID-RUBBER-BAND-LIGATION

CPT 46221: Rubber Band Ligation of Internal Hemorrhoid

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
207RH0000X	Colorectal Surgery	Specialists who commonly perform hemorrhoidectomies and fissure excision.
207L00000X	General Surgery	General surgeons who perform anorectal procedures in ambulatory and hospital settings.
207V00000X	Gastroenterology	May be involved in diagnosis, triage, and nonoperative management; less commonly performs surgical excision.
2080P0102X	Family Medicine	May perform minor anorectal procedures in select practice settings or refer to surgery.
207K00000X	Colon & Rectal Surgery (alternate taxonomy)	Additional colorectal specialty taxonomy used by some providers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K64.8`	Other specified hemorrhoids	Captures hemorrhoidal disease involving multiple internal and external hemorrhoid groups when specific laterality or type is not further specified.
`K64.9`	Hemorrhoids, unspecified	Used when documentation indicates symptomatic hemorrhoids but lacks specificity; often used for initial billing when precise type is not documented.
`K60.2`	Anal fissure, chronic	Direct clinical indication for fissure excision performed concurrently with hemorrhoidectomy.
`K64.0`	First degree hemorrhoids (internal)	Applicable when internal hemorrhoids are a primary contributor to symptoms and are excised.
`K64.1`	Second degree hemorrhoids (internal)	Applicable for prolapsing internal hemorrhoids requiring excision.
`K64.4`	External hemorrhoids, without mention of complication	Relevant when external hemorrhoidal tissue is excised in combination with internal hemorrhoids.
`K64.5`	External hemorrhoids with complication	Used if external hemorrhoids have associated thrombosis or ulceration requiring excision.
`R10.9`	Abdominal pain, unspecified	May be listed as a secondary symptom prompting evaluation; not a primary diagnosis for excision but can co-occur.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46255`	Excision of internal hemorrhoids, 1st degree or single group, any method	May be used when only a single internal hemorrhoid group is excised; less extensive than `46261`.
`46257`	Excision of internal hemorrhoids, each additional group (List separately in addition to code for primary group)	Billed in conjunction with primary hemorrhoidectomy codes when additional internal hemorrhoid groups are excised.
`46040`	Incision and drainage of anal abscess; simple or multiple	May precede or accompany hemorrhoidal procedures if an abscess or sepsis is present and needs management.
`48999`	Unlisted procedure, rectum and anus	Used only when a procedure performed is not described by existing CPT codes; rarely needed for standard hemorrhoidectomy with fissure excision.
`45330`	Anoscopy, diagnostic; without biopsy	Commonly performed preoperatively to evaluate hemorrhoids and fissures; may be performed in clinic or OR as part of evaluation.

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