Summary & Overview
CPT 46946: Excision of Two or More Hemorrhoids (Non-Rubber Band)
CPT code 46946 denotes excision of two or more hemorrhoids or hemorrhoidal groups using methods other than rubber band ligation. Nationally relevant because hemorrhoidal disease is common and procedural treatment patterns influence outpatient surgical utilization, payment variability, and care setting decisions. This code captures definitive procedural management for patients with multiple symptomatic hemorrhoids when non-band methods are employed.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context, typical sites of service, and common billing practices tied to CPT code 46946.
The publication provides benchmarks and comparative context for payment and utilization where available, highlights policy or coding considerations that affect reimbursement and claim adjudication, and outlines providers’ coding and documentation implications associated with performing multi-hemorrhoid excision. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 46946 describes a procedure in which the provider removes two or more hemorrhoids or hemorrhoidal groups using techniques other than the rubber band method. Hemorrhoids are small, swollen vascular structures in the rectal or anal canal that can cause bleeding, pain, or prolapse when symptomatic.
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Service type: Surgical removal of multiple hemorrhoids using non–rubber band techniques.
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also occur in an office setting when procedural capability permits.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to a colorectal or general surgery clinic with symptomatic internal hemorrhoids refractory to conservative therapy (dietary fiber, stool softeners, topical agents). Symptoms include bleeding with defecation, prolapse, mucous discharge, or discomfort. After history and anorectal examination, anoscopy confirms two or more internal hemorrhoids or grouped hemorrhoidal columns suitable for office-based or ambulatory procedure. The provider discusses procedural options and obtains informed consent. The patient is prepared in an endoscopy or procedure room; local anesthesia with or without sedation is administered per facility protocol. The provider performs a non-banding hemorrhoidectomy technique (for example, excisional hemorrhoidectomy using scalpel or electrocautery, or stapled hemorrhoidopexy if applicable) addressing two or more hemorrhoidal columns. Post-procedure, hemostasis is confirmed, dressings applied as needed, and discharge instructions provided. Typical sites of service are an ambulatory surgery center or hospital outpatient department; in-office minor procedure setting may be used when appropriate equipment and staffing are available.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure | When a distinct evaluation and management visit is performed on the same day as the hemorrhoid procedure |
22 | Increased procedural services | When work, time, or complexity substantially exceeds the usual for 46946 and documentation supports extra payment |
59 | Distinct procedural service | When another separate, unrelated procedure is performed at a different anatomic site or session the same day |
51 | Multiple procedures | When additional distinct procedures are billed on the same day; facility or payer rules may require modifier use or reduced payment |
52 | Reduced services | When the procedure is partially reduced or not completed as planned |
53 | Discontinued procedure | When the procedure is started but discontinued due to extenuating circumstances |
62 | Two surgeons | When two surgeons work together as primary surgeons performing distinct parts of the procedure |
80 | Assistant surgeon | When a qualified assistant surgeon is present and assists during the procedure |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | When an advanced practice clinician serves as assistant at surgery per payer rules |
26 | Professional component | When the billing entity is reporting only the professional component separate from technical services |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207P00000X | General Surgery | Common specialty performing hemorrhoidectomy and office-based anorectal procedures |
| 207R00000X | Colon & Rectal Surgery | Specialists who frequently perform hemorrhoid procedures including operative hemorrhoidectomy |
| 151M00000X | Family Medicine | May perform office-based anorectal procedures and manage pre/postoperative care |
| 207L00000X | Gastroenterology | Performs diagnostic anoscopy/colonoscopy and may refer or perform select anorectal procedures |
| 363A00000X | Nurse Practitioner | May assist, perform in-office procedures, and provide perioperative management where allowed |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K64.0 | First degree hemorrhoids | Early internal hemorrhoidal disease; may be treated conservatively but can progress and require procedural intervention |
K64.1 | Second degree hemorrhoids | Hemorrhoids that prolapse with defecation and reduce spontaneously; commonly treated with office procedures or surgical techniques when symptomatic |
K64.2 | Third degree hemorrhoids | Prolapsed hemorrhoids requiring manual reduction; often an indication for procedural removal when symptomatic |
K64.3 | Fourth degree hemorrhoids | Irreducible prolapsed hemorrhoids; frequently require operative hemorrhoidectomy |
K64.4 | Thrombosed hemorrhoids | Acute thrombosis can present with pain and may be treated with thrombectomy or excision |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
46010 | Incision and drainage, pilonidal cyst or sinus | May be performed when concurrent pilonidal disease is present in the sacrococcygeal region during evaluation |
56260 | Examination of anorectum with anoscopy, simple | Often performed before hemorrhoid procedures for diagnostic confirmation and procedural planning |
45378 | Colonoscopy, flexible, proximal to splenic flexure with biopsy, single or multiple | Performed before or after to evaluate lower GI bleeding when indicated by chronic rectal bleeding |
49505 | Repair initial inguinal hernia, age 5 years or older; reducible | Example of other outpatient surgical procedures performed in the same facility; listed for context in surgical scheduling |
99152 | Moderate sedation service provided by physician anesthesiologist (for the procedure) | Reported when moderate sedation is furnished by the physician providing sedation for the hemorrhoid procedure |