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The procedure described by CPT® Code 46288 involves the closure of an anal fistula using a rectal advancement flap technique. This surgical approach is specifically indicated for high perianal fistulas, which are located in the upper two-thirds of the external anal sphincter. High perianal fistulas present a unique challenge in surgical management, as traditional methods such as opening or excising the fistula can lead to significant complications, particularly the risk of incontinence due to disruption of the external anal sphincter. The procedure begins with the identification of the external opening of the fistula, followed by the insertion of a probe to accurately locate the internal opening. Once identified, the internal opening is excised to facilitate proper closure. The surgical technique involves mobilizing the mucosa and submucosa, along with a small amount of muscle fibers, from the internal sphincter. It is crucial to maintain a sufficiently wide base for the flap to ensure adequate blood supply and healing. After curettage of the fistula tract, the internal opening is intentionally left open to promote drainage. The advancement flap is then sutured over the internal fistula opening to achieve closure. In some cases, fibrin glue may be applied through the external opening to enhance the sealing of the flap, ensuring that the integrity of the flap is not compromised during this process.
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The closure of an anal fistula with a rectal advancement flap, as described by CPT® Code 46288, is indicated for specific conditions related to high perianal fistulas. These indications include:
The procedure for the closure of an anal fistula with a rectal advancement flap involves several critical steps, each designed to ensure effective closure while minimizing complications. The steps are as follows:
Post-procedure care following the closure of an anal fistula with a rectal advancement flap is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or excessive bleeding. Pain management may be provided as needed, and patients are advised on proper hygiene practices to maintain the surgical site. Follow-up appointments are crucial to assess the healing process and to ensure that the flap is integrating properly. Patients may also receive instructions regarding dietary modifications to prevent straining during bowel movements, which can impact the healing of the surgical site. Overall, careful adherence to post-procedure care guidelines is vital for a successful recovery and to minimize the risk of recurrence of the fistula.
| Short Descr | REPAIR ANAL FISTULA | Medium Descr | CLSR ANAL FSTL W/RCT ADVMNT FLAP | Long Descr | Closure of anal fistula with rectal advancement flap | 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) | P1G - Major procedure - 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). | AG | Primary physician | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | KX | Requirements specified in the medical policy have been met | 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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| 1995-01-01 | Added | First appearance in code book in 1995. |
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