CPT 46045 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 46045: Transanal Incision and Drainage of Rectal/Perirectal Abscess

CPT code 46045 represents transanal incision and drainage of a rectal or perirectal abscess performed under anesthesia. This is an acute surgical procedure used to evacuate pus and control local infection, and it has implications for hospital and ambulatory surgical utilization, perioperative care requirements, and coding accuracy for postoperative global periods. Nationally, accurate coding of this procedure affects reimbursements, quality tracking for abscess management, and resource planning for operating room time and anesthesia services.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context for the procedure, typical sites of service, and the types of benchmarks and policy items that commonly accompany analyses of surgical drainage procedures—such as utilization benchmarks, billing practice considerations, and relevant coverage policy themes. Where available, analyses typically cover payment benchmarks, global period implications, and common billing modifiers; if specific payer policy details are required, consult each payer directly.

This publication provides clinicians, practice managers, and coding professionals with an operational summary of CPT code 46045, highlights of why precise reporting matters at a national level, and an outline of the topics addressed in the full guidance, including billing considerations, service line placement, and clinical context for abscess management.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare46045CPTsurgeryanorectal proceduresincision and drainageambulatory surgeryoperating roominfection management

Billing Code Overview

CPT code 46045 describes an operative procedure in which the provider incises and drains pus from an abscess of the rectum or a nearby perirectal area by accessing the collection through the anal canal. The procedure is performed with the patient under anesthesia and involves exploration and drainage at the appropriate tissue layers to evacuate purulent material.

Service type: Surgical drainage of rectal or perirectal abscess through the anal canal
Typical site of service: Operating room or procedure suite with anesthesia support (inpatient or ambulatory surgical setting)

Clinical & Coding Specifications

Clinical Context

A typical patient is a 35–55-year-old adult presenting to the emergency department or ambulatory surgical center with perianal pain, swelling, erythema, and fever consistent with an anorectal abscess. Clinical evaluation includes history, focused anorectal exam, and, when indicated, bedside ultrasound or pelvic imaging to define abscess extent. The patient is taken to a minor procedure room or operating room, placed under appropriate anesthesia (local with sedation, spinal, or general), and positioned in lithotomy. The treating surgeon performs an anal canal approach incision and drainage through the sphincter complex to establish drainage of multiloculated pus from perirectal spaces, irrigates the cavity, removes loculations as needed, and places packing or a drain if indicated. Post-procedure care includes analgesia, wound care instructions, possible antibiotics for systemic signs or immunocompromise, and scheduling of follow-up for wound inspection and evaluation for fistula formation.

Coding Specifications

Modifier	Description	When to Use
`00`	(No specific CMS meaning; included in list)	Data not available in the input.
`11`	Default (Office or other outpatient)

CPT 46060: Incision and Drainage of Perirectal Abscess with Fistula Management

CPT-46030-ANAL-SETON-REMOVAL-ANAL-FISTULA

CPT 46030: Removal of Anal Seton or Marker for Anal Fistula

CPT-46050-PERIANAL-SUPERFICIAL-ABSCESS-INCISION-DRAINAGE

CPT 46050: Incision and Drainage of Superficial Perianal Abscess

CPT-46070-ANAL-MEMBRANE-INCISION-INFANT

CPT 46070: Incision of Congenital Anal Membrane in Infant

CPT-46083-EXTERNAL-HEMORRHOID-THROMBECTOMY-INCISION-DRAINAGE

CPT 46083: Incision and Thrombectomy of External Hemorrhoid

CPT-46020-ANAL-SETON-PLACEMENT

CPT 46020: Anal Seton Placement, Minor Anorectal Surgery

CPT-46080-ANAL-SPHINCTEROTOMY-RELEASE-OF-ANAL-CONTRACTURE

CPT 46080: Anal Sphincterotomy to Release Anal Contracture

CPT-46040-INCISION-DRAINAGE-ANORECTAL-ISCHIORECTAL-ABSCESS

CPT 46040: Incision and Drainage of Anorectal/Ischiorectal Abscess

Taxonomy Code	Specialty	Notes
207P00000X	Colon & Rectal Surgery	Primary specialty performing complex anorectal abscess drainage and management.
207L00000X	General Surgery	Common provider for incision and drainage of perirectal abscesses in OR or facility setting.
207RA0000X	Family Medicine	May perform incision and drainage in clinic or ED settings for superficial perianal abscesses or arrange operative care.
207T00000X	Emergency Medicine	Frequently performs initial evaluation and may perform bedside drainage or coordinate operative care.
207VC0100X	Gastroenterology	Involved in diagnosis and follow-up, particularly when fistula-in-ano or Crohn disease is a concern.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K61.0`	Perianal abscess	Direct indication for incision and drainage via a transanal or perianal approach.
`K61.1`	Ischiorectal abscess	Deep perirectal infection often requiring transanal drainage and possible multilayer dissection.
`K61.2`	Intersphincteric abscess	Abscess located between internal and external sphincter; anatomically related to transanal drainage approaches.
`K60.3`	Anal fistula, unspecified	May be identified concurrently or develop after abscess drainage; often requires follow-up and possible fistulotomy.
`K50.011`	Crohn disease of small intestine with rectal bleeding (example Crohn disease code)	Underlying inflammatory bowel disease increases risk of perianal abscess and may alter management and follow-up.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46045`	Incision and drainage of perirectal abscess; transanal approach, incision through sphincteric complex with drainage at different layers under anesthesia	Primary procedure: direct description of the operative drainage via anal canal (the billed code).
`46040`	Incision and drainage of perirectal abscess; simple perianal or perirectal approach, superficial abscess without transanal sphincterotomy	Alternative/related: used for more superficial perianal abscesses that do not require transanal sphincterotomy.
`46970`	Fistulotomy or fistulectomy, superficial	Common subsequent or concurrent procedure when an associated anal fistula is identified and treated during drainage or at follow-up.
`99152`	Anesthesia for procedures on the perineum and lower abdomen; for procedures of 30–90 minutes, patient <1 year or older with complicated anesthesia (example anesthesia codes vary by payer)	Ancillary service: anesthesia services commonly reported when patient receives monitored anesthesia care or general anesthesia for `46045`.
`12031`	Repair, intermediate, simple (e.g., wound closure)	Potential adjunct: used for repair of associated perianal lacerations or incidental external skin wounds if closed during the same encounter.

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