Local Coverage Article Billing and Coding

Billing and Coding: Infrared Coagulation (IRC) of Hemorrhoids

A54038

Expand All | Collapse All

Contractor Information

Article Information

General Information

Article ID
A54038
Article Title
Billing and Coding: Infrared Coagulation (IRC) of Hemorrhoids
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/17/2019
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Title 42 CFR §419 Prospective Payment System for Hospital Outpatient Department Services

Title 42 CFR §419.22 Hospital services excluded from payment under the hospital outpatient prospective payment system

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 9, §100 Frequency of Billing and Same Day Billing.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Infrared Coagulation (IRC) of Hemorrhoids L34422.

Payment for Infrared Coagulation of Hemorrhoids (IRC) will only be allowed once per beneficiary per global period (90 days), regardless of how many IRC treatment sessions occur or how many providers render the treatment within the same global period. If, during the initial treatment episode (defined as the 90-day global period commencing with the initial IRC treatment) the IRC treatment has not satisfactorily resolved symptoms, then another method of treatment should be considered. Payment for such alternative hemorrhoid treatments will not be made more than once per beneficiary during any treatment episode in addition to the payment for the initial IRC treatment. (For subsequent treatment, please see the next paragraph.)

If the hemorrhoids recur subsequent to the initial treatment episode, payment is subject to the same restrictions noted above.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is a statutory exclusion, has no Medicare benefit category or is rendered for screening purposes.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

For CPT® code 46930-Destruction of internal hemorrhoid(s) by thermal energy (e.g., infrared coagulation, cautery, radio-frequency), only one unit of service should be submitted no matter how many sites are treated per session.

Group 1 Codes
CodeDescription
46930 DESTRUCTION OF INTERNAL HEMORRHOID(S) BY THERMAL ENERGY (EG, INFRARED COAGULATION, CAUTERY, RADIOFREQUENCY)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(3 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
K64.0 First degree hemorrhoids
K64.1 Second degree hemorrhoids
K64.2 Third degree hemorrhoids

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/17/2019 R4

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Infrared Coagulation (IRC) of Hemorrhoids L34422 LCD and placed in this article.

05/30/2019 R3

Under Article Title changed the title to Billing and Coding: Infrared Coagulation (IRC) of Hemorrhoids. Under Article Text added the paragraphs “The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Infrared Coagulation (IRC) of Hemorrhoids L34422.” and “Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is a statutory exclusion, has no Medicare benefit category or is rendered for screening purposes.” All coding located in the Coding Information section has been removed from the related Infrared Coagulation (IRC) of Hemorrhoids L34422 LCD and added to this article. Under CPT/HCPCS Codes Group 1: Paragraph added the statement “For CPT® code 46930-Destruction of internal hemorrhoid(s) by thermal energy (e.g., infrared coagulation, cautery, radio-frequency), only one unit of service should be submitted no matter how many sites are treated per session.”

01/29/2018 R2 The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this article begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.
03/16/2017 R1 Revisions made to verbiage under Article Text to read, “Payment for Infrared Coagulation of Hemorrhoids (IRC) will only be allowed once per beneficiary per global period (90 days), regardless of how many IRC treatment sessions occur or how many providers render the treatment within the same global period. If, during the initial treatment episode (defined as the 90-day global period commencing with the initial IRC treatment) the IRC treatment has not satisfactorily resolved symptoms, then another method of treatment should be considered. Payment for such alternative hemorrhoid treatments will not be made more than once per beneficiary during any treatment episode in addition to the payment for the initial IRC treatment. (For subsequent treatment, please see the next paragraph.)

If the hemorrhoids recur subsequent to the initial treatment episode, payment is subject to the same restrictions noted above.”

Associated Documents

Related Local Coverage Documents
LCDs
L34422 - Infrared Coagulation (IRC) of Hemorrhoids
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
10/07/2019 10/17/2019 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Hemorrhoids
  • IRC