How To Use CPT Code 46280

CPT 46280 describes the surgical treatment of anal fistula, specifically in cases where the fistula is complex or multiple. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 46280?

CPT 46280 is used to describe the surgical treatment of anal fistula, specifically in cases where the fistula is complex or multiple. This code is used when the provider performs a fistulectomy or fistulotomy in the high anal areas, such as the suprasphincteric, transsphincteric, or extrasphincteric regions of the anal canal. The procedure may also involve the placement of a seton to aid in drainage and healing.

2. Official Description

The official description of CPT code 46280 is: ‘Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed.’

3. Procedure

1. During the procedure, the provider treats complex or multiple anal fistulas located in the high anal areas.
2. The provider may perform a fistulectomy or fistulotomy, which involves opening the fistula tract and dividing the internal and external sphincters.
3. If a muscle is part of the fistula tract, the provider may only open a part of the tract and place a seton at the lower part of the tract.
4. A seton is a suture or stitch that is passed through the fistula to maintain drainage, aid in healing, and preserve continence.

4. Qualifying circumstances

CPT 46280 is used for patients with complex or multiple anal fistulas located in the high anal areas, such as the suprasphincteric, transsphincteric, or extrasphincteric regions of the anal canal. The procedure may also involve the placement of a seton. It is important to note that CPT code 46280 should not be reported in conjunction with CPT code 46020.

5. When to use CPT code 46280

CPT code 46280 should be used when the provider performs a surgical treatment for complex or multiple anal fistulas in the high anal areas. This code should not be used for other types of anal fistula treatments or for simple fistulas. It is important to review the documentation and confirm that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 46280, the provider must document the following information:

• Patient’s diagnosis of complex or multiple anal fistulas
• Description of the procedure performed, including whether a fistulectomy or fistulotomy was performed
• Location of the fistulas (transsphincteric, suprasphincteric, extrasphincteric)
• Details of any seton placement
• Any additional procedures performed during the same session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 46280, ensure that the procedure meets the specific criteria outlined in the code description. It is important to review the documentation and confirm that the procedure performed aligns with the requirements of the code. CPT code 46280 should not be reported in conjunction with CPT code 46020. It is also important to follow any additional billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT code 46280 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a historical change on January 1, 2010, with the addition of a new code for the surgical treatment of complex or multiple anal fistulas with or without placement of a seton.

9. Examples

1. A provider performs a surgical treatment for a patient with multiple anal fistulas in the suprasphincteric region, including the placement of a seton.
2. A patient undergoes a surgical treatment for a complex anal fistula in the transsphincteric region, with the provider performing a fistulotomy and placing a seton.
3. A provider treats a patient with multiple anorectal fistulas closer to the anorectal ring, performing a fistulectomy and placing a seton.
4. A patient with complex anal fistulas in the extrasphincteric region undergoes a surgical treatment, including a fistulotomy and seton placement.
5. A provider performs a surgical treatment for a patient with multiple anal fistulas in the high anal areas, performing a fistulectomy and placing a seton to aid in drainage and healing.
6. A patient undergoes a surgical treatment for complex anal fistulas in the suprasphincteric region, with the provider performing a fistulotomy and placing a seton to preserve continence.
7. A provider treats a patient with multiple anorectal fistulas closer to the anorectal ring, performing a fistulectomy and placing a seton to aid in healing and maintain drainage.
8. A patient with complex anal fistulas in the extrasphincteric region undergoes a surgical treatment, including a fistulotomy and seton placement to aid in drainage and healing.