How To Use CPT Code 46070

CPT 46070 describes the procedure of incising a congenital membrane present in the anal opening of an infant. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 46070?

CPT 46070 is used to describe the incision of a congenital membrane found in the anal opening of an infant. This procedure is performed by a healthcare provider and involves making a sharp incision with a scalpel to remove the membrane and allow for proper functioning of the anus.

2. Official Description

The official description of CPT code 46070 is: ‘Incision, anal septum (infant).’ It is important to note that for anoplasty, a different set of codes should be used (46700 – 46705). Additionally, modifier 63 should not be reported in conjunction with 46070.

3. Procedure

In this procedure, the healthcare provider makes an incision in the anal septum, which is a congenital membrane present in the infant’s anal opening. The patient is appropriately prepped and anesthetized before the procedure begins. The provider locates the anal septum within the anus and uses a scalpel to make a sharp incision. Any bleeding is controlled, and the area may be irrigated with antibiotics to prevent infection.

4. Qualifying circumstances

CPT 46070 is performed on infants who have a congenital membrane in their anal opening that is causing obstruction or other issues. This procedure is necessary to remove the membrane and allow for proper functioning of the anus. It is important to note that this code should not be used for anoplasty procedures, which have their own set of codes (46700 – 46705).

5. When to use CPT code 46070

CPT code 46070 should be used when a healthcare provider performs an incision to remove a congenital membrane in the anal opening of an infant. It is important to ensure that the procedure meets the specific criteria outlined in the official description and that it is not anoplasty, which requires different codes.

6. Documentation requirements

To support a claim for CPT 46070, the healthcare provider must document the following information:

• Patient’s age and diagnosis of a congenital membrane in the anal opening
• Description of the procedure performed, including the use of a scalpel to make a sharp incision
• Date of the procedure
• Any additional details or complications encountered during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 46070, ensure that the procedure performed meets the criteria outlined in the official description. It is important to use the appropriate code for the specific procedure and not to report modifier 63 in conjunction with 46070. Additionally, it is important to follow any specific billing guidelines provided by the payer or insurance company.

8. Historical information

CPT 46070 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 46070

Five similar codes to CPT 46070 include:

• CPT 46020: Incision of anal sphincter
• CPT 46030: Incision of anal sphincter, complicated
• CPT 46040: Incision of anal sphincter, complicated, with drainage
• CPT 46050: Incision of anal sphincter, complicated, with fistulectomy
• CPT 46083: Incision of anal sphincter, complicated, with fistulotomy

9. Examples

1. A healthcare provider performs an incision to remove a congenital membrane in the anal opening of an infant.
2. During the procedure, the provider uses a scalpel to make a sharp incision in the anal septum, allowing for proper functioning of the anus.
3. An infant with a congenital membrane causing obstruction undergoes an incision procedure to remove the membrane and improve anal function.
4. A healthcare provider performs an incision of the anal septum in an infant with a congenital membrane, ensuring proper drainage and functioning of the anus.
5. During the procedure, the provider carefully incises the congenital membrane in the anal opening of an infant, relieving any obstruction and allowing for normal bowel movements.
6. An infant with a congenital membrane in the anal opening undergoes an incision procedure to remove the membrane and restore proper anal function.
7. A healthcare provider performs an incision of the anal septum in an infant with a congenital membrane, ensuring proper healing and functioning of the anus.
8. During the procedure, the provider makes a precise incision in the anal septum of an infant, removing the congenital membrane and promoting normal bowel movements.
9. An infant with a congenital membrane causing discomfort and obstruction undergoes an incision procedure to remove the membrane and improve anal function.
10. A healthcare provider performs an incision of the anal septum in an infant with a congenital membrane, ensuring proper healing and functioning of the anus.