What is Hemwellectomy?

Hemwellectomy induces vasospasm and thrombosis in the hemorrhoid’s feeder arterial branches of the rectal arteries, cutting off its blood supply while the veins remain open, which causes the hemorrhoids to shrink.

Minimally Invasive

The procedure is performed under local anesthesia in an outpatient setting, avoiding the risks and recovery associated with traditional surgical hemorrhoidectomy.

Safe and Effective

By delivering a controlled direct current to the hemorrhoidal vessels, the technology ligates arterial feeders while preserving venous outflow achieving high efficacy across all grades (I–IV) with minimal complications.

Patient Centered Innovation

FDA-Cleared and backed by leading specialists, HemWell MD provides lasting relief with rapid recovery, making advanced hemorrhoid care accessible, reimbursable, and significantly less disruptive to patients’ lives.

Hemwellectomy applies a precisely controlled low-energy direct current to the arterial feeders of the hemorrhoid, inducing vasospasm and permanent vessel closure without thermal injury or excision. The current also produces a localized electrochemical effect, generating visible hydrogen bubbles and the alkaline environment that accelerates tissue breakdown.

Sustained low-energy direct current promotes damage to endothelial cell membranes. Promoting intravascular clot formation, sealing, and permanently ligating the vessels. This unique mechanism of action addresses the underlying vascular pathology rather than removing tissue, resulting in a safe, effective, and minimally invasive solution for all grades of hemorrhoids with rapid recovery and minimal patient discomfort.

The Hemwellectomy procedure is FDA-Cleared and has demonstrated excellent safety and efficacy in clinical trials.

The before image shows light reflecting off a concave rectal bulge, reported as a grade III hemorrhoid. Immediately following the procedure, two points marked as 1 and 2 indicate the locations where the electrodes contacted the hemorrhoid. Most notable is the normal mucosa between these two points. Minimal mucosal blackening is seen at the highest electron flux, suggesting submucosal thrombosis or denaturing of the serum albumin at these sites. The relatively normal mucosa confirms the Hemwellectomy is Nonthermal. No necrotic tissue, no tissue coagulation, or ulceration is seen. With relatively little tissue damage, one expects minimal pain, infection, or complications, explaining why the Hemwellectomy is relatively painless and free from complications such as infection, incontinence, and excessive bleeding.

November 11, 2022
From: KarenZupko & Associates, INC, Matthew Twetten, MA, MHCDS

Thank you for the opportunity to review the Electronic Inquiry #13659 and the updated response from AMA Knowledgebase on September 7, 2022. Hemwell has provided KarenZupkoandAssociates with procedure descriptions and redacted operative notes in addition to the previous notes and descriptions.

By way of background, my professional experience includes 18 years as staff for physician specialty societies and as staff liaison to the AMA CPT Editorial Panel. I have authored multiple coding and policy articles for publications such as AAOS Now and SpineLine. I have authored multiple CPT coding applications and presented directly to the CPT Editorial Panel on multiple occasions. I have a Masters in Healthcare Delivery Science from Dartmouth University and Masters of Arts from the State University of New York-Binghamton and I have extensive background with surgical coding and auditing.

Based on a review of relevant clinical publications and illustrations which are shown below as references, my expert opinion is that CPT code 46945, Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance is the most appropriate CPT code to describe the work involved in the procedure done with the Hemwell device. CPT code 46945 describes the destruction of blood supply to the hemorrhoid and does not specify “by suture” or any other method of delivering the ligation beyond noting it is other than rubber band.

Ligation is defined to be the result of the closing off of blood flow to a location. That closure can be achieve by suture, banding, clipping, sealing, etc. The delivery mechanism is not the defining component of the procedure or the work done by a physician in addressing the injury/abnormality requiring correction.

CPT guidance is to use the most similar and appropriate code for a procedure and work involved and my review of CPT codes for hemorrhoid treatment leads me to conclude that CPT 46945 is the most appropriate CPT code for the work done with the Hemwell hemorrhoid device and that other hemorrhoid treatment codes like CPT code 46930, Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency) or 46250, Hemorrhoidectomy, internal and external, single column/group are not correct.

Furthermore, my assessment is that CPT code 46999, Unlisted Procedure, Anus is not appropriate in this instance because 46945 is specific to the work done with the Hemwell device, which is ligation.

Please note that this is my coding advice and interpretation based on the review of the 2022 CPT Professional and the 2022 Medicare Physician Fee Schedule. Our recommendations are made on the basis of materials provided to us by the client and available in CPT Professional and other referenced sources.

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