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The CPT® Code 46275 refers to the surgical treatment of an anal fistula, specifically through intersphincteric fistulectomy or fistulotomy. An anal fistula is defined as an abnormal connection between two epithelial surfaces, typically involving the anal canal and the skin surrounding the anus. This condition often arises from an infection in the anal glands, leading to the formation of a tract that can cause discomfort and other complications. During the procedure, a probe or suture may be utilized to navigate through the external opening of the fistula tract to identify the internal opening. The surgical approach involves either incising and opening the fistula tract (fistulotomy) to facilitate healing from the inside out or excising the entire fistula tract (fistulectomy). It is important to differentiate between types of anal fistulas, as the coding varies based on their anatomical location. For instance, CPT® Code 46270 is designated for subcutaneous anal fistulas, while CPT® Code 46280 is used for transsphincteric, suprasphincteric, or extrasphincteric fistulas, which are located in deeper tissues and necessitate more extensive surgical dissection. In cases where an anal seton is employed, a non-absorbable suture is inserted into the fistula tract to facilitate drainage or promote fibrosis. This seton may be left loose or tightened gradually to create a cutting effect, allowing the fistula tract to heal over time. Additionally, a two-stage procedure may be indicated to minimize the risk of incontinence when the fistula traverses the anal sphincter, involving an initial opening or excision followed by a second surgical intervention to address the remaining fistula tract.
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The surgical treatment of an anal fistula using CPT® Code 46275 is indicated for patients presenting with the following conditions:
The procedure for CPT® Code 46275 involves several critical steps to effectively treat the intersphincteric anal fistula:
After the surgical treatment of an intersphincteric 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 from the surgical site. Patients may be advised to maintain proper hygiene in the anal area to promote healing. Pain management may be necessary, and the healthcare provider may prescribe analgesics as needed. Follow-up appointments are crucial to assess the healing process and determine if further intervention is required, especially if a two-stage procedure was performed. Patients should also be educated on potential complications, including the risk of incontinence or recurrence of the fistula, and instructed to report any concerning symptoms promptly.
| Short Descr | REMOVE ANAL FIST INTER | Medium Descr | SURG TX ANAL FISTULA INTERSPHINCTERIC | Long Descr | Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric | 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 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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 | 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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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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