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A surgical treatment for anal fistula, specifically coded as CPT® Code 46270, involves the procedures of fistulotomy or fistulectomy targeting subcutaneous anal fistulas. An anal fistula is defined as an abnormal connection between two epithelial surfaces, typically resulting from an infection or abscess in the anal region. The procedure begins with the identification of the fistula tract, which may involve the use of a probe or suture to trace the external opening to its internal counterpart. Once the tract is located, the surgeon can either incise and open the fistula (fistulotomy) to facilitate healing from the inside out or excise the entire tract (fistulectomy). This surgical intervention is crucial for alleviating symptoms associated with anal fistulas, such as pain and discharge, and promoting proper healing. It is important to note that different codes are used for various types of anal fistulas based on their complexity and location, with CPT® Code 46270 specifically designated for subcutaneous anal fistulas. The procedure may also involve the placement of an anal seton, which is a length of non-absorbable suture material used to manage the fistula tract, either for drainage or to gradually open the tract over time. This comprehensive approach aims to minimize complications, such as incontinence, particularly when the fistula traverses the anal sphincter.
© Copyright 2025 Coding Ahead. All rights reserved.
The surgical treatment of anal fistula using CPT® Code 46270 is indicated for the following conditions:
The procedure for surgical treatment of a subcutaneous anal fistula involves several key steps:
After the surgical treatment of a subcutaneous anal fistula, patients can expect specific post-procedure care and considerations. It is essential to monitor for any signs of infection, such as increased pain, swelling, or discharge. Patients may be advised to maintain proper hygiene in the anal area and may receive instructions on wound care. Pain management may be necessary, and follow-up appointments will be scheduled to assess healing and determine if further treatment is required. If an anal seton was placed, patients will need to follow specific guidelines regarding its care and any adjustments that may be necessary over time. Overall, the recovery process will vary based on the complexity of the procedure and the individual patient's condition.
| Short Descr | REMOVE ANAL FIST SUBQ | Medium Descr | SURG TX ANAL FISTULA SUBQ | Long Descr | Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 96 - Other OR lower GI therapeutic procedures |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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