A Complete Health Care Facility

PRADER, BRACKER, & ASSOCIATES

A Complete Health Care Facility

159 Healthcare Way • SOMEWHERE, FL 32811 • 407-555-6789

PATIENT: HOLLAND, FELECIA

ACCOUNT/EHR #: HOLLFE001

DATE: 04/26/22

Attending Physician: Oscar R. Prader, MD

This 31-year-old female is 32-weeks pregnant. She presents today in tears. She is suffering from hemorrhoids and cannot stand it anymore. The pain and itching are making life difficult for her, as it hurts to sit for any length of time, and she cannot sleep. As it is difficult for her to lie on her stomach, due to the pregnancy, she can only find some comfort by either walking around or lying on her side. She is asking (more like begging) for a hemorrhoidectomy—a simple surgical procedure that can be done in the office and will almost immediately provide her with complete relief.

The correct CPT code for the treatment of Felecia’s condition is

46260 Hemorrhoidectomy, internal and external, 2 or more columns/groups

However, Felecia’s insurance carrier will not pay for a hemorrhoidectomy with a diagnosis that indicates there are no complications. According to the insurance customer service representative, it will only pay in full for the procedure

46250 Hemorrhoidectomy, external, 2 or more columns/groups

Felecia’s husband, Ben, is a civilian who works for a defense contractor and is currently in Iraq supporting the troops. Money is tight for the family because Ben’s paycheck has been delayed due to a mix-up in paperwork when he was transferred to the Middle East. There is no way they can afford to pay cash for the hemorrhoidectomy.

All you need to do is change the one number of the code and Felecia can have the relief she so desperately needs. As the professional coding specialist in this office, what should you do?