Summary & Overview
CPT 46320: Excision of External Thrombosed Hemorrhoid
CPT code 46320 denotes the surgical excision of an external thrombosed hemorrhoid—removal of a swollen, blood-filled vein in the anal canal distal to the dentate line. This procedure is clinically significant because it addresses acute pain, reduces risk of infection and recurrent thrombosis, and is commonly billed across ambulatory surgery centers, hospital outpatient departments, and select office settings. Nationally, proper coding of 46320 affects procedural reporting, quality measurement, and payment for proctologic surgical services.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent, typical sites of service, and the role it plays in surgical proctology billing. The publication outlines common modifiers associated with surgical procedures, benchmarking context where available, and operational considerations for claims submission. It also summarizes clinical context that justifies use of the code, including indications for excision of acute thrombosis.
This piece provides a national perspective for revenue cycle and clinical teams seeking to understand the billing classification, expected settings for service delivery, and the documentation focus needed to support use of CPT code 46320. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 46320 describes the excision of an external thrombosed hemorrhoid, a surgical procedure to remove a swollen vein or cluster of veins containing blood located in the anal canal distal to the dentate line. The service involves surgical removal of the thrombosed tissue to relieve pain and prevent complications.
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Service type: Surgical excision of external thrombosed hemorrhoid
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in an office setting when appropriate
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient surgical clinic or ambulatory surgery center with acute pain and a tender, palpable lump at the anal verge. The patient reports sudden onset of severe perianal pain, often associated with straining, constipation, or prolonged sitting. Examination reveals a bluish, thrombosed external hemorrhoid located distal to the dentate line with intact skin and no evidence of systemic infection. Local anesthesia (injection or field block) is administered and the provider performs excision of the thrombosed external hemorrhoid using scalpel or scissors, evacuating the clot and excising redundant tissue. The procedure is commonly completed under local anesthesia with or without minimal sedation in the office, procedure room, or ambulatory surgery center. Typical workflow: triage and history, focused anorectal exam, informed consent, procedural anesthesia and positioning, excision and hemostasis, dressings and postprocedural instructions, and follow-up plan for pain control and wound care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a distinct E/M visit is documented on the same day as 46320 (e.g., new acute evaluation leading to procedure). |