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Physicians Success

Innovation In Hemorrhoid Treatment

Direct Current Electrotherapy Of Internal Hemorrhoids: An Effective, Safe And Painless Outpatient Approach.

Physicians Success

Daniel A. Norman, M.D., F.A.C.P., Ronald Newton, B.S., and Glenn V. Nicholas, D.C. University of Nevada, School of Medicine, Reno, Nevada and Barton Memorial Hospital, South Lake Tahoe, California

METHODS: One hundred twenty consecutive patients with symptomatic hemorrhoid disease completed d.c. electrotherapy. All underwent historical review, and visual and digital examination. No bowel preparation, oral or parenteral medication therapy was required. Digital and anoscopy were performed with Hinkle-James rectal speculum with an operative port exposing one-eighth of the circumference of the anal canal. Subjects with source other than hemorrhoid disease accounting for their symtomatology were excluded from the study.

No major complications occurred in the treatment of 590 diseased hemorrhoid segments. Minor complications were noted in two patients. One patient experienced a vasovagal episode with syncope for 10 s after treatment with out apparent sequelae. He returned for additional treatment without adverse effect. One patient experienced rectal pain after treatment, which resolved in hours with a sitz bath. This did not occur with subsequent treatment. Direct current therapy of hemorrhoid disease is a safe treatment approach.

Direct current offsets many concerns raised with other hemorrhoid therapies. It is successful on all grades of internal and mixed hemorrhoid disease. Properly applied the procedure is painless. No bowel preparation, anesthetic, or medication is required. Patients are able to resume normal activities immediately after therapy. No major and only rare minor complications without sequelae dictate the safety of the procedure. Apparent sustained symptom resolution can be expected, and patient acceptance is good. However, more than one treatment is required in about one-fourth of the patients.

Comparison Of Electrotherapy, Rubber Band Ligation And Hemorrhoidectomy In The Treatment Of Hemorrhoids: A Clinical And Manometric Study

A Izadpanah, 1 ,* SV Hosseini, 2 and M Mahjoob 1

METHODS: A total of 150 patients with symptomatic grades II or III internal hemorrhoids were randomly assigned to three groups. Group A underwent Ferguson hemorrhoidectomy, group B were treated with rubber band ligation (RBL) and group C were treated with direct current electrotherapy.

CONCLUSION: We conclude that electrotherapy is a safe, effective and simple method of treating grades II and III uncomplicated internal hemorrhoids. This procedure is associated with little postoperative pain and complications, and has the least changes in anorectal manometric characteristics. Therefore electrotherapy maybe recommended as a treatment of choice for grades II and III uncomplicated internal hemorrhoids.

RBL, despite the lack of significant effect on anorectal manometry seems to be inferior to the electrotherapy method due to the presence of rare, but major side effects and more pain associated with this modality. Finally, we determined that electrotherapy is a good choice for the treatment of grades II and III internal hemorrhoids due to its high success rate, low cost, ease of procedure, lack of significant side effects, significantly less postoperative pain, and most importantly, minimal anorectal physiological change. Thus, we can recommend this procedure as one of the options of choice for treating internal hemorrhoids.

Evaluating The Safety, Efficacy And Complications Of Electrotherapy And Its Comparison With Conventional Method Of Hemorrhoidectomy

Payam Nikooiyan,1 Hamzeh Mohammadi Sardo,2 Bahram Poursaeidi,3 Motahareh Zaherara,4 and Bijan Ahmadi5

PATIENTS AND METHODS: This randomized clinical trial was performed on patients with hemorrhoids referring to hospitals affiliated to the Kerman University of Medical Sciences during 2014-2015. One hundred and twenty patients presented with symptomatic hemorrhoids grade I, II, III, and IV were randomized into two groups. Group 1 (60 patients) underwent electrotherapy using 30 mA direct current and group 2 (60 patients) were submitted to Ferguson hemorrhoidectomy. The groups were compared regarding postoperative pain severity and complications, including recurrent symptoms, infection and recovery time to return to normal activities. The p≤ 0.05 was considered statistically significant.

RESULTS: More than 70% of patients in group 2 complained of severe pain, but in group 1, no more than 30% of patients experienced severe pain up to 6 hours post-surgery and 70% complained of mild pain 2-3 days post-surgery. Twenty four-hour hospitalization in group 2 and group 1 were 97% and 78%, respectively, whilst patients in electrotherapy group could be treated as outpatients. The mean return time to usual activities was 15 and 1.5 days for group 2 and 1, respectively.

CONCLUSION: Electrotherapy with a direct current of 30 mA significantly reduce postoperative pain and the recovery period. This method showed a good success rate and less complication than the Ferguson method. As a result, because of more effectiveness, less pain, as well as shorter recovery time and getting back to normal activities, we recommend this procedure for the treatment of symptomatic hemorrhoids grade I, II, and III.

Billing Information

EXAMPLE 1: HemWell – HEMORRHOIDECTOMY WITHOUT COMPLEMENTING PROCEDURES

CPT code 46946 is used if the physician treated two or more hemorrhoid columns. If only one hemorrhoid column is treated, then CPT code 46945 applies.

Facility Billing: Medicare Outpatient Hospital Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid
    columns/groups
  • APC 0149
  • Payment: $2,237.33
  • Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid
    column/group
  • APC: 0149
  • Payment: $2,237.33
Facility Billing: Medicare Ambulatory Surgery Center Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid
    columns/groups
  • Payment: $1,100.20
  • Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid
    column/group
  • Payment: $1,100.20
Professional Billing: Medicare Physician Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber
    band; 2 or more hemorrhoid columns/groups
  • Total RVUs
    • Non-Facility: 8.79
    • Facility: 6.38
  • Payment:
    • Non-Facility: $349.93
    • Facility: $349.93
  • Hemorrhoidectomy, internal, by ligation other than rubber band;
    single hemorrhoid column/ group
  • Total RVUs
    • Non-Facility: 8.59
    • Facility: 6.36
  • Payment:
    • Non-Facility: $309.06
    • Facility: $309.06

EXAMPLE 2: HemWell HEMORRHOIDECTOMY WITH COLONOSCOPY

Facility Billing: Medicare Outpatient Hospital Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber band; single
    hemorrhoid columns/groups
  • APC 0149
  • Payment: $2,237.33
  • Payment (With Multi-Procedure Adjustment): $2,237.33
  • Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without
    collection of specimen(s) by brushing or washing, with or without colon
    decompression (separate procedure)
  • APC: 0143
  • Payment: $724.89
  • Payment (With Multi-Procedure Adjustment): $352.45
Facility Billing: Medicare Ambulatory Surgery Center Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber band; a single
    hemorrhoid columns/groups
  • Payment: $1,100.20
  • Payment (With Multi-Procedure Adjustment): $1,100.20
  • Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without
    collection of specimen(s) by brushing or washing, with or without colon
    decompression (separate procedure)
  • Payment: $363.42
  • Payment (With Multi-Procedure Adjustment): $181.71
Professional Billing: Medicare Physician Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid columns/groups
  • Total RVUs
    • Non-Facility: 8.79
    • Facility: 6.38
  • Payment:
    • Non-Facility: $309.06
    • Facility: $309.06
  • Payment (With Multi-Procedure Adjustment):
    • Non-Facility: $309.06
    • Facility: $N/A
  • Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
  • Total RVUs
    • Non-Facility: 11.03
    • Facility: 6.19
  • Payment:
    • Non-Facility: $339.96
    • Facility: $193.08
  • Payment (With Multi-Procedure Adjustment):
    • Non-Facility: $165.42
    • Facility: $96.54

EXAMPLE 3: HemWell HEMORRHOIDECTOMY WITH COLONOSCOPY

Facility Billing: Medicare Outpatient Hospital Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups
  • APC 0149
  • Payment: $2,237.33
  • Payment (With Multi-Procedure Adjustment): $2,237.33
  • Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
  • APC: 0143
  • Payment: $724.89
  • Payment (With Multi-Procedure Adjustment): $352.45
Facility Billing: Medicare Ambulatory Surgery Center Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups
  • Payment: $1,100.00
  • Payment (With Multi-Procedure Adjustment): $1,100.00
  • Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
  • Payment: $363.42
  • Payment (With Multi-Procedure Adjustment): $181.71
Professional Billing: Medicare Physician Reimbursement
  • Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups
  • Total RVUs
    • Non-Facility: 8.79
    • Facility: 6.38
  • Payment:
    • Non-Facility: $391.93
    • Facility: $391.93
  • Payment (With Multi-Procedure Adjustment):
    • Non-Facility: $391.93
    • Facility: $391.93
  • Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
  • Total RVUs
    • Non-Facility: 11.03
    • Facility: 6.19
  • Payment:
    • Non-Facility: $339.96
    • Facility: $193.08
  • Payment (With Multi-Procedure Adjustment):
    • Non-Facility: $165.42
    • Facility: $96.54

Sample Endoscopy Center ROI

Average Monthly Cases (Pre-Covid)      1,200
Average Monthly Colons (60% Total Cases)      720
Estimated Utilization Rate of 30% Monthly      216
Average Reimbursement Per Case      $1,110
Per Case Usage Charge from HemWell      $250
Net Revenue Gain Per Case      $850
216 Colons/Month X Net Revenue      $183,600
Yearly Facility Revenue at 216/Month      $2,203,200
Physician Reimbursement Per Case (46945 only)      $309.06
Yearly Physician Revenue at 216/Month (Average)      $801.08

Compare Fees And See How Much MORE
You Can Earn With HemWell!

Colonoscopy With Banding

(Medicare National Average)
$246.49
  • Facility Fee for the ASC, 45398: $507.42
  • Cost of Banding Device (approx.): $ 100.00
  • Total Facility Fee Net: $407.42 Net
  • Professional Fee for 45398: $246.49

Colonoscopy With Sclerotherapy

(Medicare National Average)
$276.29
  • Facility Fee for the ASC, 45378: $ 363.42
  • Facility Fee for the ASC, 46500
  • (2nd Procedure @1/2 of $235.67 * ½): $117.84
  • Combined procedure reimbursement $ 481.26
  • Cost of Banding Device (approx.): $75.00
  • Total Facility Fee Net: $406.26 Net
  • Professional Fee for 45378: $193.08
  • Professional Fee for 46500: $83.21
  • Total Prof. Fee: $276.29

Colonoscopy With Sclerotherapy

(Medicare)
$343.08 /Net
  • Facility Fee for the ASC, 45378: $363.42
  • Total Facility Fee Net: $363.42 Net
  • Professional Fee for 45378: $193.08
  • Professional Fee for 46221 (OFFICE): $250.00
  • Cost of Banding device (approx.): $100.00
  • Total Professional Fee: $343.08 Net

How Do We RETREAT A Patient?

Banding In The Office

(Medicare)
$150.00/Net
  • Professional Fee for 46221 (OFFICE): $250.00
  • Cost of Banding device (approx.): $100.00
  • Total Professional Fee: $150.00 Net