CPT code 46255 – Single-column hemorrhoidectomy, internal and external

Key takeaways

CPT code 46255 reports excision of one hemorrhoid column or group, with its internal and external components removed together.

Two or more columns excised is 46260, so the operative note must name each column by position.

Adding a fissurectomy moves the claim to 46257, and adding a fistulectomy moves it to 46258.

The 2026 national Medicare rate is about $351 in a facility and $581 outside one, with a 90-day global period.

Most 46255 denials trace back to a column-count mismatch, a missing prior authorization, or anoscopy billed without a modifier.

CPT code 46255 covers one column, inside and out

CPT code 46255 reports a hemorrhoidectomy that removes one hemorrhoid column or group, with its internal and external parts. The official descriptor reads Hemorrhoidectomy, internal and external, single column/group. The AMA maintains it in the Surgery section, within the Anus subsection (46020-46999).

Hemorrhoids usually form in three primary columns: right anterior, right posterior, and left lateral. Excise one of them, with tissue above and below the dentate line, and the case is 46255. Excise two or more in the same session, and it becomes 46260.

Older references still describe this family as “simple” and “complex” hemorrhoidectomy. CPT retired that wording in 2010. Today, the column count decides the code, along with any fissurectomy or fistulectomy done in the same session.

• Unit of count: One hemorrhoid column or group.
• Components: Internal and external tissue, excised together.
• Code family: 46250-46262, the excisional hemorrhoidectomy series.
• Global period: 90 days.
• Not this code: Incision of a thrombosed hemorrhoid and rubber band ligation (46221) each have their own codes.

Each surgical step leaves something to confirm

So what does the surgeon actually do? A single-column hemorrhoidectomy follows a set sequence, and each step shows up in the operative report.

1. Patient positioning: The patient lies in lithotomy or prone jackknife position. A retractor exposes the anal canal.
2. Identification: The surgeon finds the diseased column and confirms its extent above and below the dentate line.
3. Excision: The column is excised with its internal and external components, rather than incised or drained.
4. Ligation: The vascular pedicle is suture-ligated at the apex to control bleeding.
5. Wound management: The Ferguson (closed) technique closes the wound with absorbable suture. The Milligan-Morgan (open) technique leaves it open to heal by secondary intention.

Either closure technique fits 46255, so the technique never changes the code. The number of excised columns in the note does.

Column count decides between 46255 and 46260

The 46250-46262 series splits on two questions. How many columns were excised? Was a fissure or fistula treated in the same session? The grid below maps each answer pair to one code.

Here’s a worked example. The note reads “large right posterior column excised, internal and external components, pedicle ligated.” That is one column with both parts, so the code is 46255. If the same note also lists the left lateral column, the claim becomes 46260.

The table spells out each descriptor in the series for reference.

Getting the count wrong costs money either way. Billing 46255 for a two-column case underpays the surgeon. Billing 46260 when the note names one column is an overcode, and auditors spot it quickly.

Excision, not incision, is what 46255 pays for

Excision removes the hemorrhoid. Incision, by contrast, opens a thrombosed external hemorrhoid and evacuates the clot. Payers treat them as different procedures with different codes.

A 46255 claim on a chart that documents only incision and drainage is an overcode. The correct code is 46083, or 46320 when the thrombosed hemorrhoid was excised. Reviewers compare the note with the descriptor, so this mismatch is an easy audit finding.

A graded K64 code supports medical necessity

Once the procedure code is settled, the diagnosis has to justify it. Medical necessity for 46255 rests on a K64 code. Surgery is typically indicated for grade III or IV hemorrhoids. Grade II qualifies after conservative and office-based treatment has failed.

Grade does not choose between 46255 and 46260. A grade IV case with one diseased column is still 46255. A grade III case with three columns is 46260. Always code the documented grade, because K64.9 (unspecified hemorrhoids) invites a records request when the chart states one.

Medicare pays about $351 for CPT code 46255 in a facility

Medicare sets payment for 46255 through the CMS Medicare Physician Fee Schedule. The figures below are 2026 national unadjusted values at the $33.4009 conversion factor.

Local payment varies with the geographic practice cost index (GPCI) for your Medicare Administrative Contractor (MAC) locality. Confirm current figures in the CMS lookup or an RVU lookup tool before you set fees.

The 90-day global period bundles routine post-operative visits into the 46255 payment. An evaluation and management (E/M) visit for an unrelated problem in that window takes modifier -24. An unrelated procedure takes modifier -79.

Prior authorization for 46255 depends on the payer

Prior authorization (PA) for 46255 isn’t universal. Still, it’s common enough that skipping the check leads to avoidable denials. That’s why the medical billing process for elective surgery usually starts with a payer-specific PA check.

• Traditional Medicare (Parts A and B): Generally does not require PA for 46255 under current CMS policy. Confirm with your MAC, since local coverage determinations (LCDs) can change.
• Medicare Advantage plans: Requirements vary by plan. Many require PA for elective anorectal surgery, with criteria on grade and failed conservative treatment.
• Commercial insurance: Most commercial payers require PA for elective hemorrhoidectomy. Include the grade, the operative plan, and the failed conservative care (diet, fiber, topical therapy, office procedures).
• Medicaid: Requirements are state-specific, and managed Medicaid plans often require PA for elective anorectal procedures.

A PA request should carry the K64 code, the grade, the duration of symptoms, and a summary of failed non-surgical treatment. If the payer denies the PA and surgery goes ahead anyway, expect the claim to be denied too.

A 46255 claim moves through six checkpoints

With authorization settled, the claim itself starts to take shape. Here’s the path a typical 46255 claim takes, from booking to payment.

1. Scheduling: The front desk verifies eligibility and checks whether the plan needs PA.
2. Surgery and the note: The surgeon dictates the operative report and names each excised column by position.
3. Coding: The coder counts columns, checks for fissure or fistula work, and assigns the graded K64 code.
4. Charge entry: The biller adds modifiers, the authorization number, and any same-day services.
5. Submission: The claim passes clearinghouse edits before it reaches the payer.
6. Remittance: The remittance advice posts payment or a denial code. Denials go back to the coder for review.

A vague note at step two holds up every later step. The coder has to query the surgeon first, and the claim waits for the answer.

Seven details in the note keep the claim clean

A 46255 claim clears medical review when the operative report covers seven elements. Miss one, and you risk a records request or a denial.

• Technique: The note states the hemorrhoid was excised, not incised, drained, or banded.
• Column/group count: The note names each excised column by position, such as right posterior, and states the total. One column supports 46255. Two or more support 46260.
• Internal and external components: The note confirms the excision included tissue above and below the dentate line.
• Added procedures: Any fissurectomy or fistulectomy is documented, since either one moves the code to 46257 or 46258.
• Diagnosis linkage: The K64 code on the claim matches the grade recorded in the note.
• Pathology: If tissue went to pathology, the note says so. Some payers ask for the pathology report.
• Anesthesia: The note records general, regional, or monitored anesthesia care. This matters when anesthesia is billed separately.

A structured superbill keeps the CPT code, the grade, and the column count together at the point of service. For the wider claim lifecycle, see what makes a clean claim.

Five modifiers come up most with CPT 46255

Even a perfect note can stumble on a missing modifier. Modifiers tell the payer that special circumstances affected the service. These five come up most often with 46255.

NCCI edits decide what bills alongside 46255

Modifiers only work inside the bundling rules. CMS maintains National Correct Coding Initiative (NCCI) edits, which govern the codes that may be billed with 46255. Breaking one is a fast route to a rejection. Claim Adjustment Reason Code (CARC) 97 on your electronic remittance advice is usually the first sign.

• 46600 (anoscopy), bundled by default: Anoscopy done as part of the surgical approach is integral to 46255. It’s billable only for a distinct diagnostic purpose, with modifier -59 or -XS and supporting documentation.
• E/M visits around surgery, bundled: An E/M visit the day before or day of surgery is part of the global package. Modifier -57 makes it payable when that visit produced the decision to operate.
• 46257 and 46258, never with 46255: 46257 adds a fissurectomy. 46258 adds a fistulectomy, with or without fissurectomy. Each already includes the single-column hemorrhoidectomy, so bill only the full-procedure code.
• 46260, an alternative and not a pair: Count the columns and report one code. Never bill 46255 and 46260 for the same session.
• Surgical pathology, separately billable: The pathologist reports the exam of excised hemorrhoid tissue, usually with 88304. It isn’t bundled into the surgeon’s 46255 payment.

CMS updates the NCCI edit tables quarterly. Before treating a code pair as billable, check the current table at cms.gov. The AAPC Codify CPT lookup also shows active edits next to each code.

Most 46255 denials trace back to five mistakes

When a claim does come back, the reason usually falls into one of five groups. Good denial management sorts each one by root cause, beyond the payer’s response code. A list of medical billing denial codes helps coding teams resolve each type.

Run this check before a 46255 claim goes out

Before you submit, run through these six points. Each one maps to a denial in the table above.

• The operative note names each excised column by position, and the total is one.
• The note confirms that internal and external tissue were both excised.
• No fissurectomy or fistulectomy was performed. If one was, the code is 46257 or 46258.
• The K64 code matches the documented grade. The chart shows failed conservative treatment where the payer needs it.
• Prior authorization is on file for plans that require it.
• Any anoscopy or same-day E/M on the claim has a documented reason and the right modifier.

How claims management software keeps 46255 claims moving

Much of the rework on 46255 claims starts with retyping. A biller copies the CPT code, the K64 code, and the authorization number from the chart into a claim form. Each copy is another chance for a mismatch.

Pabau, the practice management platform we build, pre-fills the claim from the patient record instead. The CPT code attached to the service lands on the charge line. Diagnosis slots are seeded from the recorded problem list. Our claims management software also checks required fields, like the member ID and authorization number, before the claim can go.

In the US, claims go out through Claim.MD, with instant eligibility checks, claim-status tracking, and remittance posting. That leaves your billing team free to focus on the operative note and the column count.

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Pabau pre-fills each claim from the patient record, checks required fields before submission, and sends US claims through Claim.MD. See the workflow in a live demo.

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Conclusion

The biggest win on 46255 sits upstream of billing. When every operative note names the excised columns by position, coders stop guessing and auditors stop asking.

So start with the note template, then pair it with a graded K64 code and a quarterly NCCI check. The cost is a few extra lines per report. That is far cheaper than reworking a single denied claim.

Book a demo to see how Pabau carries the code, grade, and authorization from the chart onto a clean hemorrhoidectomy claim.

Continue your research

Need to understand how claims flow from practice to payer? Medical claims clearinghouse guide explains how clearinghouses validate, scrub, and route claims before they reach Medicare or commercial payers.

Dealing with recurring denials across your anorectal billing? Claim.MD clearinghouse overview covers how real-time eligibility checks and ERA processing reduce denial rates at the clearinghouse level.

Want a structured approach to billing compliance? Medical billing compliance guide covers audit triggers, documentation standards, and payer-specific policy review cycles for surgical specialties.

Need the full hemorrhoid diagnosis range? ICD-10 codes for hemorrhoids walks through K64.0-K64.9, from first-degree disease to skin tags and unspecified codes.

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