CPT 46262 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

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

CPT code 46262 represents surgical excision of two or more columns or groups of internal and external hemorrhoids and may include concurrent removal of an anal fistula and/or an anal fissure. This operative code is relevant nationally for surgical practices, ambulatory surgery centers, hospitals, and payers because it captures a multi-component anorectal procedure that can affect coding, billing, and resource utilization for colorectal and general surgery services. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context of the procedure, typical sites of service, payer coverage considerations, and how this code is used in surgical billing workflows. The publication also outlines benchmarks commonly analyzed for operative codes of this complexity, highlights relevant policy updates affecting surgical coding and reimbursement, and provides concise guidance on documentation elements that support medical necessity. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 46262hemorrhoidectomyanorectal surgerysurgical codingambulatory surgery centercolorectal surgeryprocedure codingoperative report

Billing Code Overview

CPT code 46262 describes a surgical procedure in which the provider excises two or more columns or groups of internal and external hemorrhoids. The procedure may also include removal of an associated anal fistula and excision of an anal fissure (an open sore of the lower rectum) when present.

Service type: Surgical excision of hemorrhoidal tissue with possible concurrent fistula and fissure removal
Typical site of service: Ambulatory surgical center or hospital operating room, often performed by colorectal surgeons, general surgeons, or proctologists

Clinical & Coding Specifications

Clinical Context

A 46-year-old patient presents to an outpatient ambulatory surgery center with chronic symptomatic hemorrhoidal disease involving multiple internal and external hemorrhoid columns and a concomitant low rectal fistula and chronic anal fissure. Conservative care (fiber, topical agents, office procedures) has failed and the colorectal surgeon schedules an operative excision. Under monitored anesthesia care or general anesthesia, the surgeon performs an excision of two or more columns/groups of internal and external hemorrhoids (46262), dissects and excises the low intersphincteric fistula tract with appropriate curettage and closure, and addresses the chronic fissure with lateral internal sphincterotomy or fissure excision as indicated. Intraoperative steps include patient positioning in lithotomy, anoscopic visualization, hemostasis with electrocautery, tissue excision of hemorrhoidal bundles, fistula tract identification and removal, and repair of the anal mucosa as needed. Postoperative workflow includes recovery unit monitoring, multimodal analgesia, stool softeners, wound/dressing instructions, and an outpatient follow-up visit within 1–2 weeks for wound check and symptom assessment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds usual for and documentation supports the increased services.

CPT 46285: Staged Fistula Repair, Second-Stage Procedure

CPT-46260-HEMORRHOIDECTOMY-TWO-OR-MORE-HEMORRHOIDS

CPT 46260: Excision of Two or More Internal and External Hemorrhoids

CPT-46275-INTERSPHINCTERIC-ANAL-FISTULA-PROCEDURE

CPT 46275: Intersphincteric Anal Fistula Surgery

CPT-46320-EXCISION-EXTERNAL-THROMBOSED-HEMORRHOID

CPT 46320: Excision of External Thrombosed Hemorrhoid

CPT-46221-HEMORRHOID-RUBBER-BAND-LIGATION

CPT 46221: Rubber Band Ligation of Internal Hemorrhoid

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

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

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

CPT 46280: Complex Anorectal Fistula Surgery, Possible Seton Placement

CPT-46258-HEMORRHOID-FISTULA-FISSURE-EXCISION

CPT 46258: Excision of Hemorrhoid Group with Fistula and Fissure

CPT-46200-ANAL-FISSURE-EXCISION-SPHINCTEROTOMY

CPT 46200: Excision of Anal Fissure with Possible Sphincterotomy

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

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

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46262

Taxonomy Code	Specialty	Notes
207P00000X	Colon and Rectal Surgery	Primary specialty performing complex hemorrhoidectomy and fistula/fissure procedures.
207L00000X	Surgery – General	General surgeons commonly perform anorectal excisions in OR or ambulatory settings.
2080S0122X	Gastroenterology	Gastroenterologists may perform anoscopic or office-based procedures; operative hemorrhoidectomy typically by surgeons.
363A00000X	Anesthesiology	Provides monitored anesthesia care or general anesthesia during `46262`.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K64.4`	External hemorrhoids, chronic	External hemorrhoids that may require excision as part of `46262`.
`K64.8`	Other hemorrhoids	Multiple hemorrhoidal columns when more specific code not applicable.
`K60.2`	Anal fissure, chronic	Chronic fissure may be excised or addressed during the same operative session.
`K60.3`	Anal fissure, unspecified	Used when documentation does not specify acute vs chronic.
`K60.4`	Anal fistula	Fistula tract excision or fistulectomy often occurs alongside hemorrhoidectomy.
`K64.0`	First degree hemorrhoids	May be present but typically not the primary indication for surgical excision in `46262`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46050`	Drainage of anorectal abscess; simple	May be performed before or during operative management of anorectal sepsis when abscess is present.
`46221`	Hemorrhoidectomy, internal, by submucous resection (hemorrhoidectomy), single column	Less extensive hemorrhoidectomy for a single column; `46262` covers excision of two or more columns/groups.
`46255`	Hemorrhoidectomy, external, with or without internal component; simple, single column	Related limited excision when fewer columns are involved.
`46280`	Excision of anal fissure, fissurectomy	If fissure is excised as a distinct procedure, this code may be reported when documentation supports separate service.
`46270`	Fistulotomy or fistulectomy, simple	Used when a simple anal fistula is incised or excised; can be reported when fistula management is a discrete component.

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