How To Use CPT Code 46275

CPT 46275 describes the surgical treatment of an anal fistula known as intersphincteric fistulectomy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 46275?

CPT 46275 is used to describe the surgical treatment of an anal fistula that passes between the internal sphincter and extends downward to the perianal skin. The procedure involves dividing the internal sphincter, opening the fistula tract, and excising the roof of the fistula or removing the fistula. The wound is left open for drainage and self-healing, or a drain may be inserted for continuous drainage of the area.

2. Official Description

The official description of CPT code 46275 is: ‘Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric.’

3. Procedure

1. After appropriate prepping and anesthesia, the provider divides the internal sphincter and opens the fistula tract.
2. The provider may excise the roof of the fistula or remove the fistula.
3. If necessary, the provider performs fistulotomy by dividing the distal part of the internal sphincter.
4. The wound is left open for drainage and self-healing, or a drain may be inserted for continuous drainage of the area.

4. Qualifying circumstances

CPT 46275 is performed when the patient has an anal fistula that requires surgical treatment. The fistula must pass between the internal sphincter and extend downward to the perianal skin. The procedure is typically performed by a qualified healthcare professional who is experienced in treating anal fistulas.

5. When to use CPT code 46275

CPT code 46275 should be used when performing an intersphincteric fistulectomy, which involves the surgical treatment of an anal fistula passing between the internal sphincter and extending downward to the perianal skin. It should not be used for other types of fistulas or procedures.

6. Documentation requirements

To support a claim for CPT 46275, the healthcare professional must document the following information:

• Patient’s diagnosis of an anal fistula requiring surgical treatment
• Description of the procedure performed, including the division of the internal sphincter, opening of the fistula tract, and any excision or removal of the fistula
• Details of wound management, such as leaving the wound open for drainage or inserting a drain
• Any additional relevant information, such as complications or follow-up plans
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 46275, ensure that the procedure performed meets the criteria for an intersphincteric fistulectomy. It is important to accurately document the procedure and any additional services provided. CPT code 46275 should not be reported with other codes unless additional procedures or services are performed that are separately reportable.

8. Historical information

CPT 46275 was added to the Current Procedural Terminology system on January 1, 1990. The code was later changed on January 1, 2010, to specify the type of fistulectomy as intersphincteric.

9. Examples

1. A patient undergoes an intersphincteric fistulectomy to treat an anal fistula that passes between the internal sphincter and extends downward to the perianal skin.
2. A healthcare professional performs a surgical procedure to divide the internal sphincter, open the fistula tract, and excise the roof of the fistula in a patient with an intersphincteric fistula.
3. An anal fistula is surgically treated by removing the fistula and leaving the wound open for drainage in a patient who requires an intersphincteric fistulectomy.
4. A qualified healthcare professional performs a fistulotomy by dividing the distal part of the internal sphincter in a patient with an intersphincteric fistula.
5. A patient undergoes an intersphincteric fistulectomy, and a drain is inserted for continuous drainage of the area following the procedure.
6. A healthcare professional performs a surgical treatment for an anal fistula that requires an intersphincteric fistulectomy.
7. An intersphincteric fistula is surgically treated by excising the roof of the fistula and leaving the wound open for drainage.
8. A patient with an anal fistula undergoes a surgical procedure to remove the fistula and divide the distal part of the internal sphincter.
9. A qualified healthcare professional performs an intersphincteric fistulectomy to treat an anal fistula that extends downward to the perianal skin.
10. A surgical treatment is performed for an intersphincteric fistula, and the wound is left open for drainage and self-healing.