Hemorrhoids are swollen veins located around the outer part of the anus or the lowest part of your rectum. The blog lists the ICD-10 and CPT codes for the condition.

1. Coding and Documenting
Hemorrhoids – Using ICD-
10 and CPT Codes
Hemorrhoids are swollen
veins located around the
outer part of the anus or
the lowest part of your
rectum. The blog lists
the ICD-10 and CPT
codes for the condition.
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Hemorrhoids are enlarged and swollen blood vessels or veins located around the outer part
of the anus or the lowest part of your rectum. The rectum is the bottom section of the colon
(large intestine) that leads to the anus (the opening at the end of the colon where fecal
matter leaves the body). When the walls of these blood vessels are stretched, they become
irritated and bleeding occurs. When the stretching and pressure continues, the weakened
vessels protrude. Reports suggest that about half of the population experience one or more
of the classic symptoms of hemorrhoids by the age of 55 years. Hemorrhoids are rarely
dangerous, but they can be recurrent and easily treated. Proctologists or gastroenterologists
treating hemorrhoids have to ensure accurate documentation of the patient’s condition and
treatment provided. General surgery medical billing and coding is a more complex
specialty than many others when it comes to reporting diagnosis and management, and
many providers rely on medical billing and coding outsourcing companies to do so.
Also known as piles, hemorrhoids are very common in both men and women, affecting
about 1 in 20 Americans. The likelihood of developing this condition increases as a person
ages. In most cases, women are likely to develop the condition while pregnant.
Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the
anus or rectum. External hemorrhoids on the other hand, develop under the skin, outside
the anus. In some cases, blood may pool in an external hemorrhoid and form a clot
(thrombus) that can result in severe pain, swelling, inflammation and a hard lump near your
anus which is known as thrombosed hemorrhoids.
Causes and Symptoms
Hemorrhoids have a number of causes, although often the cause is unknown. Enlargement
of the veins around the anus is considered one of the primary causes of hemorrhoids.
However, experts have identified several other factors such as – straining during bowel
movements, complications from chronic constipation and diarrhea, sitting for a long period
of time (especially on the toilet), and anal intercourse as the root causes for this condition.
The condition can also occur due to aging as the tissues that support the veins in your
rectum and anus can weaken and stretch. Genetics, obesity, repeated heavy lifting of
objects, lack of fiber in the diet and pregnancy can also cause this condition.
Typically, the type of symptoms depends on the location - whether the hemorrhoid is
external (on the skin around the anus) or internal (inside the rectum) and its severity (from
mild to debilitating). Common symptoms include -

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 Painless bleeding during bowel movements
 Itching or irritation in your anal region
 Swelling around your anus
 A lump near your anus, which may be sensitive or painful (may be a thrombosed
hemorrhoid)
 Fecal leakage
 Painful bowel movements
How Are Hemorrhoids Diagnosed and Treated?
Diagnosis of this condition will generally begin with a detailed description of symptoms by
patients along with previous medical history. Physicians may also look for symptoms like -
skin irritation, lumps or swelling, skin tags (excess skin left when the blood clot in a
thrombosed hemorrhoid is absorbed by the body), external hemorrhoids, prolapsed internal
hemorrhoids and anal fissures that can lead to itching and bleeding. External hemorrhoids
are generally apparent, especially if a blood clot has formed.
Primary diagnosis of this condition will generally begin with a detailed visual examination of
the anal and rectal (anorectal) area. In order to confirm the diagnosis, your physician may
conduct a digital rectal exam to check for any abnormalities within the anus. During this
exam, your physician will insert a gloved and lubricated finger into your rectum and if they
feel anything abnormal, they may order an additional test called a sigmoidoscopy. A
sigmoidoscopy involves your doctor using a small fiber-optic camera (called a
sigmoidoscope) to obtain a clear view of your rectum (inside) so that they can examine the
hemorrhoid up close. In some cases, your physician may conduct colonoscopy to examine
the entire colon if the patient’s symptoms suggest the occurrence of any other digestive
system disease or have risk factors for colorectal cancer.
Treatment options for this condition include - over the counter (OTC) creams or
suppositories (like hydrocortisone witch hazel, or lidocaine), oral pain relievers such as
acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin IB, others) that help
temporarily relieve your discomfort from hemorrhoids.
External hemorrhoid thrombectomy procedure is opted if a painful blood clot (thrombosis)
has formed within an external hemorrhoid. Physicians can remove the clot with a simple
incision and drainage. This procedure may provide prompt relief if done within 72 hours of
developing a clot. Other minimally invasive procedures include - rubber band ligation,
Injection (sclerotherapy) and Coagulation (infrared, laser or bipolar). For patients who have

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large hemorrhoids, physicians may recommend different surgical procedures such as –
hemorrhoidectomy and stapled hemorrhoidectomy or stapled hemorrhoidopexy.
General surgery medical coding involves using the specific ICD-10 diagnosis codes, and
CPT procedure codes for reporting different types of hemorrhoid on your medical claims.
ICD-10 codes
 K64 - Hemorrhoids and perianal venous thrombosis
 K64.0 - First degree hemorrhoids
 K64.1 - Second degree hemorrhoids
 K64.2 - Third degree hemorrhoids
 K64.3 - Fourth degree hemorrhoids
 K64.4 - Residual hemorrhoidal skin tags
 K64.5 - Perianal venous thrombosis
 K64.8 - Other hemorrhoids
 K64.9 - Unspecified hemorrhoids
CPT Codes
 43227 - Esophagoscopy, flexible, transoral; with control of bleeding, any method
 43255 - Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding,
any method
 44366 - Small intestinal endoscopy, enteroscopy beyond second portion of
duodenum, not including ileum; with control of bleeding (eg, injection, bipolar
cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)
 44378 - Small intestinal endoscopy, enteroscopy beyond second portion of
duodenum, including ileum; with control of bleeding (eg, injection, bipolar cautery,
unipolar cautery, laser, heater probe, stapler, plasma coagulator)
 44391 - Colonoscopy through stoma; with control of bleeding, any method
 45334 - Sigmoidoscopy, flexible; with control of bleeding, any method
 45382 - Colonoscopy, flexible; with control of bleeding, any method
 43205 - Esophagoscopy, flexible, transoral; with band ligation of esophageal varices
 43244 - Esophagogastroduodenoscopy, flexible, transoral; with band ligation of
esophageal/gastric varices
 45350 - Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids)
 45398 - Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)
 46221 - Hemorrhoidectomy, internal, by rubber band ligation(s)

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 46945 - Hemorrhoidectomy, internal, by ligation other than rubber band; single
hemorrhoid column/group
 43192 - Esophagoscopy, rigid, transoral; with directed sub mucosal injection(s), any
substance
 43201 - Esophagoscopy, flexible, transoral; with directed sub mucosal injection(s),
any substance
 43204 - Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal
varices
 43236 - Esophagogastroduodenoscopy, flexible, transoral; with directed sub mucosal
injection(s), any substance
 43243 - Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of
esophageal/gastric varices
 44404 - Colonoscopy through stoma; with directed sub mucosal injection(s), any
substance
 45335 - Sigmoidoscopy, flexible; with directed sub mucosal injection(s), any
substance
 45381 - Colonoscopy, flexible; with directed sub mucosal injection(s), any substance
To prevent or avoid worsening of hemorrhoid symptoms several effective lifestyle habits can
be opted. Avoid over-straining during a bowel movement as this creates pressure in the
veins in the lower rectum. Increase your intake of water on a regular basis as this will help
prevent hard stools and aid in healing. Consuming plenty of foods rich in fiber, such as fruits
and vegetables, as well as whole grains can ease constipation. In addition, keep the anal
area clean – shower daily to cleanse the skin around your anus gently with warm water.
Medical coding for various general surgery procedures can be complex. Outsourcing the
medical coding tasks to a reliable and professional medical billing company can help in
accurate and timely medical billing and claims submissions. Experienced, AAPC-certified
coding specialists in these companies are knowledgeable about the nuances of reporting this
common general surgical procedure correctly.