Infrared coagulation of hemorrhoids (46930) is considered medically necessary for persistently bleeding or painful first and second degree internal hemorrhoids.  Infrared coagulation of hemorrhoids reported for indications other than those listed above should be denied as not medically necessary, and therefore, not covered. A participating, preferred, or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

Procedure code 46930 should be reported only once per operative session regardless of the number of hemorrhoids treated.

Payment may be made for a maximum of four treatments within a six-month period.

Description

Infrared coagulation (IRC), also called photocoagulation, is used to treat symptomatic first- and second-degree internal hemorrhoids. Pulses of infrared radiation are applied to the hemorrhoidal base through a hand-held applicator. These pulses produce a discreet area of necrosis, which heals to form a scar. This reduces or eliminates blood flow through the hemorrhoid, thereby shrinking it, and the mucosa becomes fixed to the underlying tissue. The procedure is easily performed in a physician’s office.

The diagnosis of internal and external hemorrhoids is made by inspection, digital examination, and direct vision through the anoscope and proctoscope. Whenever the internal hemorrhoidal plexus is enlarged, there is an associated increase in supporting mass, and the resultant venus swelling is called an internal hemorrhoid. When veins in the external hemorrhoidal plexus become enlarged, the resultant bluish mass is called an external hemorrhoid. External hemorrhoids require an incision because they are below the skin.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP.  Medical policy is not an authorization, certification, explanation of benefits or a contract.  Benefits are determined by the Federal Employee Program.

National Blue Cross Blue Shield Association Medical Policy 7.01.26, Infrared Coagulation of Hemorrhoids, 10/2003

American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Hemorrhoids, Gastroenterology, Volume 126, No. 5, 05/2004