How To Use CPT Code 46742

CPT 46742 describes the repair of a high imperforate anus with a rectourethral or rectovaginal fistula using a combined transabdominal and sacroperineal approach. 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 46742?

CPT 46742 is used to describe the surgical repair of a high imperforate anus in patients who also have a rectourethral or rectovaginal fistula. This procedure involves a combined transabdominal and sacroperineal approach to correct the malformation and create a functional anus.

2. Official Description

The official description of CPT code 46742 is: ‘Repair of high imperforate anus with rectourethral or rectovaginal fistula; combined transabdominal and sacroperineal approaches.’

3. Procedure

1. The surgeon begins by making a midline incision in the sacrum and removing the coccyx.
2. A pathway is created through the puborectalis muscle sling to reach the new anal site.
3. An abdominal incision is made to prepare the distal colon and rectum.
4. The mucosa is stripped from the distal rectum, and the urethral or vaginal fistula is identified and closed with sutures.
5. The bottom of the rectal muscle pouch is incised to bring the proximal rectum or colon out through the muscular floor and puborectalis muscle sling to the new anal site.
6. A skin incision is made at the new anal site, and the terminal part of the colon is sutured to the sphincter muscles and skin to create a new anus.
7. The incisions are closed with sutures.

4. Qualifying circumstances

CPT 46742 is performed on patients with a high imperforate anus, where the rectal opening is completely absent. These patients also have a rectourethral or rectovaginal fistula, which is an abnormal connection between the rectum and the urethra or vagina. The combined transabdominal and sacroperineal approaches are used to repair these malformations and create a functional anus.

5. When to use CPT code 46742

CPT code 46742 should be used when a surgeon performs a combined transabdominal and sacroperineal repair of a high imperforate anus with a rectourethral or rectovaginal fistula. This code should not be used for other types of repairs or approaches.

6. Documentation requirements

To support a claim for CPT 46742, the surgeon must document the following information:

• Patient’s diagnosis of a high imperforate anus with a rectourethral or rectovaginal fistula
• Details of the combined transabdominal and sacroperineal approaches used
• Date of the procedure
• Specific steps performed during the procedure
• Any complications or additional procedures performed
• Signature of the surgeon

7. Billing guidelines

When billing for CPT 46742, ensure that the procedure performed matches the description of the code. It is important to accurately document the approach used and any additional procedures performed. Modifier 63 should not be reported in conjunction with CPT 46742. Medicare considers this procedure as an inpatient-only (IPO) service.

8. Historical information

CPT 46742 was added to the Current Procedural Terminology system on January 1, 1994. The code has not undergone any updates since its addition. In 2017, Medicare added this procedure to the Inpatient Only (IPO) list, indicating that it should only be performed on an inpatient basis.

9. Examples

1. A surgeon performs a combined transabdominal and sacroperineal repair of a high imperforate anus with a rectourethral fistula in a newborn baby.
2. A surgical team uses a combined transabdominal and sacroperineal approach to repair a high imperforate anus with a rectovaginal fistula in a teenage girl.
3. A patient with a high imperforate anus and a rectourethral fistula undergoes a combined transabdominal and sacroperineal repair procedure performed by a skilled surgeon.
4. A surgeon repairs a high imperforate anus with a rectovaginal fistula using a combined transabdominal and sacroperineal approach in a young adult.
5. A newborn baby with a high imperforate anus and a rectourethral fistula undergoes a successful combined transabdominal and sacroperineal repair procedure performed by an experienced surgeon.
6. A surgical team performs a combined transabdominal and sacroperineal repair of a high imperforate anus with a rectovaginal fistula in a child.
7. A skilled surgeon repairs a high imperforate anus with a rectourethral fistula using a combined transabdominal and sacroperineal approach in an adolescent patient.