Summary & Overview
CPT 46060: Incision and Drainage of Perirectal Abscess with Fistula Management
CPT code 46060 denotes surgical management of a rectal or perirectal abscess with treatment of an associated anal fistula, potentially including seton placement. This code captures a common, acute anorectal surgical intervention that matters nationally because it involves both infection control and fistula management, procedures that can affect hospital length of stay, readmission risk, and resource utilization.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, an outline of typical settings where the service is delivered, and what to expect when this code appears on a claim. The publication also summarizes benchmarking considerations, common billing modifiers (listed separately), and policy implications affecting coverage and coding accuracy.
This summary is intended for clinicians, billing professionals, and policy analysts seeking clarity on the clinical intent of CPT code 46060, common sites of service, and the payer landscape that commonly reimburses for this surgical service. Data not available in the input on associated taxonomies, ICD-10 diagnoses, related codes, and service line are noted where applicable.
Billing Code Overview
CPT code 46060 describes an operative procedure in which the provider performs incision and drainage of a perirectal or rectal abscess and treats an associated anal fistula. The procedure may involve exploration of the fistula tract and placement of a seton when clinically indicated.
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Service type: Surgical procedure for anorectal infection and fistula management
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Typical site of service: Operating room, ambulatory surgery center, or hospital inpatient surgical suite
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient presents to the emergency department with a 3-day history of severe perianal pain, erythema, and fluctuance with fever. On exam there is a tender, fluctuant perianal mass with cellulitis consistent with a perirectal abscess; there is also purulent drainage from a chronic external opening suggesting an anal fistula. The colorectal surgeon evaluates the patient, obtains informed consent, and arranges for an urgent procedure in the operating room or procedure room under regional or general anesthesia. The provider performs incision and drainage of the perirectal/anal abscess, explores the fistula tract, places a seton when indicated, and achieves hemostasis and wound care. Postoperative orders include wound packing or drain management, analgesia, tetanus status review, and outpatient follow-up with the surgeon for wound checks and potential definitive fistula repair.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Reserved/Not commonly used by Medicare | Data not applicable for routine reporting; follow payer-specific guidance |
11 | Office/Outpatient E/M — Not a CPT modifier for procedures (place-holder in list) | Not applicable to identify professional/service; do not append to surgical code |