Summary & Overview
CPT 46200: Excision of Anal Fissure with Possible Sphincterotomy
CPT code 46200 denotes an operative procedure for excision of an anal fissure, with potential incision of the anal sphincter (sphincterotomy) to relieve sphincter spasm and promote healing. This code matters nationally because chronic anal fissures are a common anorectal complaint that can require definitive surgical management when conservative care fails; accurate coding affects clinical documentation, hospital and ambulatory surgical billing, and aggregated utilization metrics.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common sites of service, and the typical surgical intent of fissure excision with or without internal sphincterotomy. The publication provides benchmarks and coding guidance coverage patterns when available, outlines commonly reported modifiers, and summarizes implications for facility and professional billing workflows.
This national overview is intended for revenue cycle leaders, colorectal and general surgeons, coding professionals, and policy analysts who need a compact reference to CPT code 46200, its clinical role, and its relevance to payer coverage and billing practices. Data not available in the input is noted where specific payer policies, ICD-10 pairings, and related codes would normally appear.
Billing Code Overview
CPT code 46200 describes a surgical procedure to incise and remove an anal fissure, which may include incision of the anal sphincter as part of treatment. The procedure is intended to relieve pain and promote healing by excising chronic fissure tissue and, when performed, partially dividing the internal sphincter to reduce spasm.
Service Type
- Surgical procedure — anorectal surgery focused on fissure excision and possible sphincterotomy
Typical Site of Service
- Ambulatory surgical center or hospital operating room, and may also be performed in an office-based procedure setting when appropriate and supported by facility capabilities
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to a colorectal surgery or general surgery clinic with a chronic posterior midline anal fissure unresponsive to conservative measures (topical nitrates, calcium channel blockers, stool softeners, sitz baths) for ≥6–8 weeks. The patient reports severe pain with bowel movements, occasional bleeding, and sphincter spasm. After clinical evaluation, anoscopic exam, and discussion of risks/benefits, the surgeon schedules an outpatient operative procedure for fissure removal and, if indicated, a controlled internal anal sphincterotomy to relieve hypertonicity.
Preoperative workflow includes informed consent, evaluation of bleeding risk and anticoagulant management, brief pre-op history/physical, and local or monitored anesthesia care/general endotracheal anesthesia depending on patient comorbidity and preference. The procedure is commonly performed in an ambulatory surgery center or hospital outpatient department. Postoperative care includes pain control, stool softeners, wound care instructions, and short-term follow-up to assess healing and continence.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when substantially greater work is documented for unusually complex fissure excision/sphincterotomy requiring significantly more time or difficulty. |