CPT Code for Ferguson Hemorrhoidectomy with Two External Hemorrhoids
The CPT code for a Ferguson hemorrhoidectomy with two external hemorrhoids is 46250 (for the first hemorrhoid) plus 46250-59 or 46250 with modifier 51 (for the second hemorrhoid), or alternatively 46261 if both internal and external components are excised together. 1, 2
Understanding Ferguson Hemorrhoidectomy Coding
Ferguson hemorrhoidectomy is a closed hemorrhoidectomy technique where the hemorrhoid components are excised and the wounds are closed primarily, as opposed to the open Milligan-Morgan technique where wounds heal by secondary intention. 1, 2
Primary CPT Codes for Hemorrhoidectomy
- CPT 46250: Hemorrhoidectomy, external, 2 or more columns/groups 3
- CPT 46255: Hemorrhoidectomy, internal and external, single column/group 3
- CPT 46257: Hemorrhoidectomy, internal and external, 2-3 columns/groups 3
- CPT 46260: Hemorrhoidectomy, internal and external, 4 or more columns/groups 3
- CPT 46261: Hemorrhoidectomy, internal and external, single column/group (with fissurectomy) 3
Coding Decision Algorithm
For two external hemorrhoids specifically:
- If only external components are being excised (no internal component involvement), use CPT 46250 3
- This code covers "2 or more columns/groups" of external hemorrhoids 3
- If there are both internal and external components being excised together (mixed hemorrhoids), use CPT 46257 for 2-3 columns/groups 3
Critical Coding Considerations
- The Ferguson technique involves excising both internal and external components of each hemorrhoid when present, making it typically a combined internal-external procedure 2, 4
- Do not separately code internal and external components when they are part of the same hemorrhoidal complex - this is considered bundled 1
- The number of "columns" or "groups" refers to the anatomical distribution (typically right anterior, right posterior, and left lateral positions) 1
- Two external hemorrhoids would typically fall under the "2 or more" category for external-only procedures 3
Common Coding Pitfalls to Avoid
- Never use modifier 51 inappropriately - CPT 46250 already accounts for "2 or more" hemorrhoids, so additional modifiers are not needed for the second hemorrhoid when using this code 3
- Do not confuse thrombosed external hemorrhoid excision (CPT 46083) with formal hemorrhoidectomy - these are different procedures 3
- Ensure documentation clearly specifies whether internal components were also excised, as this changes the code from 46250 to 46257 1, 2
Documentation Requirements
The operative note should clearly document:
- Number of hemorrhoid columns/groups excised 1
- Whether internal, external, or combined components were removed 2
- Specific technique used (Ferguson closed technique with primary closure) 2, 5
- Any complications or additional procedures performed 4
Most likely scenario: If performing a true Ferguson hemorrhoidectomy on two external hemorrhoids, CPT 46250 is the appropriate single code, as it covers "2 or more columns/groups" of external hemorrhoids. 3