Summary & Overview
CPT 46070: Incision of Congenital Anal Membrane in Infant
CPT code 46070 denotes surgical incision of a congenital membrane at the anal opening in an infant, a focused pediatric procedure to restore anal patency. Nationally, this code is used in pediatric surgical cases addressing congenital anorectal membrane or imperforate membrane presentations that require minor operative management. Accurate coding supports appropriate clinical documentation, billing consistency, and claims adjudication for a rare but important neonatal surgical intervention.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, coding context, and what to expect when this service is billed across major payers. The publication summarizes typical sites of service, common billing considerations, and benchmarking pointers where available.
This summary provides clinical context for coding, outlines the service setting, and highlights payer coverage scope. It also indicates where input data are incomplete: when specific payer policies, modifiers, associated taxonomies, or ICD-10 diagnosis pairings are not provided, the notation "Data not available in the input." is used. The intent is to give a national audience clear, actionable information about CPT code 46070 without making practice recommendations.
Billing Code Overview
CPT code 46070 describes an operative procedure to incise a congenital membrane at the anal opening of an infant. This procedure addresses a congenital obstruction of the anal canal caused by a persistent membrane that prevents normal patency.
Service type: Surgical procedure — congenital anorectal membrane incision
Typical site of service: Inpatient or outpatient pediatric surgical setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
An otherwise healthy newborn or young infant presents with failure to pass meconium within the first 24–48 hours of life or with progressive abdominal distention and difficulty with stooling. On physical examination the anal opening appears narrowed or there is a thin congenital anal membrane (anovestibular or anal membrane/atresia) partially occluding the anal orifice. After initial newborn stabilization and diaper care, the pediatrician or pediatric surgeon evaluates the infant, documents the obstructing membrane, and consents the parents for a minor procedure. The procedure 46070 (incision of congenital membrane of anal opening) is typically performed in an outpatient surgical suite, newborn nursery, or pediatric operating room under local anesthesia with or without sedation, or brief general anesthesia depending on patient age and institutional policy.
The workflow includes pre-procedure verification, surgical site marking, sterile prep, direct visualization of the membrane, and a careful incision or excision to open the anal canal. Hemostasis is obtained with local measures, and stooling is observed prior to discharge. Post-procedure documentation includes indication, anesthesia type, estimated blood loss (usually minimal), any complications, and discharge instructions for wound care and follow-up with pediatric surgery or primary care to ensure normal bowel function and healing.
Coding Specifications
| Modifier | Description | When to Use |
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