We hope everyone is well and enjoying 2017 so far! In this edition, we’re going to provide information on internal vs. external hemorrhoids, share our hemorrhoid banding call script with you, and address CMS changes to tracking Post-Op Visits.
Broadly speaking, there are two types of hemorrhoids: internal hemorrhoids, those that occur inside the lower rectum above the dentate line, and external hemorrhoids, those that occur below the dentate line and are often observed as external lumps or bulges around the anus.
Because they are inside the lower rectum, internal hemorrhoids often can’t be seen and are typically painless. Often, the only symptoms patients may notice are itching, small amounts of bright red blood (on toilet paper or inside the toilet bowl), or a feeling of fullness following a bowel movement. However, internal hemorrhoids can also push through the anal opening (these are known as prolapsing hemorrhoids).
By contrast, external hemorrhoids often occur as bulges or lumps around the anus and are observable by patients. Due to the sensitive nerve fibers in this area, these abnormal vessels are often painful, especially when sitting. They may also bleed and itch.
Because of the visible nature of external hemorrhoids, you may often hear from your patients, “I don’t have internal hemorrhoids – it’s my externals that are bothering me!” However, external hemorrhoid-like symptoms are often actually caused by internal hemorrhoids. The patient is just more aware of the external changes so assumes that is where all of the symptoms are coming from! That’s why band ligation of internal hemorrhoids takes care of the “external” problems approximately 90% of the time.
So, whether your patient is complaining of internal or external symptoms, the most important thing is to schedule the patient for consultation with a physician. Most likely, their “external” symptoms will be relieved by banding their internal hemorrhoids, and if not, the physician can determine the best course of action for the patient.
CRH used to own and operate 17 clinics around the United States where all we did was hemorrhoid banding with the CRH O’Regan System. All scheduling was done through a central call center and in order to help the staff in addressing patients’ questions and ultimately schedule patients for the procedure, we used a call script, which you download by clicking here. Feel free to customize it to fit your practice’s needs.
We’ve had some questions come in about the upcoming CMS changes to Post-Op Visit Tracking as it pertains to hemorrhoid band ligation, which our Medical Director covered extensively in his most recent banding bulletin.
These changes do not come into effect until July 1st, 2017 and when they do, only practices in FL, KY, LA, NV, NJ, ND, OH, OR and RI with 10+ practitioners will be impacted. If your practice has fewer than 10 practitioners or is not in one of these 9 states, you will not be affected.