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The CPT® Code 46280 refers to the surgical treatment of anal fistulas, specifically through procedures known as fistulectomy or fistulotomy. An anal fistula is defined as an abnormal passage that connects one epithelial surface to another, typically resulting from an infection or abscess in the anal region. The procedure is indicated for various types of anal fistulas, including transsphincteric, suprasphincteric, extrasphincteric, or multiple fistulas. These classifications indicate the depth and complexity of the fistula, with transsphincteric, suprasphincteric, and extrasphincteric fistulas being located in deeper tissues, necessitating more extensive surgical dissection to accurately locate and treat the fistula tract. 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 may involve incising and opening the fistula tract (fistulotomy) to facilitate healing from the inside out, or excising the fistula tract entirely (fistulectomy). In cases where a seton is placed, a non-absorbable suture material is inserted into the external opening of the fistula tract, passed through the internal opening, and then pulled back out of the anal canal. This seton can be left loose for drainage and fibrosis or can be a cutting type seton, which gradually opens the fistulous tract over time. The procedure may also be performed in two stages to minimize the risk of incontinence, particularly when the fistula traverses the anal sphincter. In the first stage, part of the fistula is treated, allowing for healing before addressing the remainder in a subsequent surgical session.
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The surgical treatment of anal fistulas using CPT® Code 46280 is indicated for the following conditions:
The procedure for the surgical treatment of anal fistulas as described by CPT® Code 46280 involves several key steps:
After the surgical treatment of anal fistulas, patients may require specific post-procedure care to ensure proper healing and recovery. This may include monitoring for signs of infection, managing pain, and following specific wound care instructions. Patients are typically advised to maintain good hygiene in the anal area and may be prescribed medications to manage discomfort. Follow-up appointments are essential to assess healing and determine if further intervention is necessary, especially in cases where a two-stage procedure was performed. The expected recovery time can vary based on the complexity of the fistula and the surgical approach taken.
| Short Descr | REMOVE ANAL FIST COMPLEX | Medium Descr | TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON | Long Descr | Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | ET | Emergency services | 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 |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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