Summary & Overview
CPT 46270: Incision and Excision/Incision of Fistula Tract
CPT code 46270 denotes a surgical incision and removal or incision of a fistula tract. It is used when a clinician directly addresses a cutaneous or subcutaneous fistulous tract through incision and excision or simple incision to facilitate healing or drainage. Nationally, this code matters because such minor surgical interventions are commonly performed across ambulatory surgery centers, hospital outpatient departments, and office-based procedure settings, impacting surgical utilization, outpatient surgical capacity, and payer reimbursement patterns.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical scope, typical sites of service, and the payer landscape. The publication also provides benchmarks where available, clarity on common billing practice considerations, and contextual clinical information about indications and setting of service.
This summary equips coding managers, practice administrators, and policy analysts with a clear description of the procedure represented by 46270, the primary payers to consider in reimbursement and coverage discussions, and the topics addressed in the full publication, including coding guidance, payment benchmarking, and clinical context. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 46270 describes a surgical procedure in which the provider makes an incision through the skin overlying a fistula and either removes or incises the fistula tract as part of treatment. This procedure is a minor operative intervention focused on resolving symptomatic or persistent cutaneous or subcutaneous fistulous tracts.
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Service type: Surgical procedure — incision and excision/incision of fistula tract
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Typical site of service: Ambulatory surgery center, hospital outpatient department, or office-based procedure room depending on clinical complexity and facility capability
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the outpatient surgical clinic with a chronically draining cutaneous opening along the right perianal region consistent with a cutaneous fistula. The patient reports recurrent local irritation, occasional seropurulent drainage, and intermittent pain despite conservative measures (sitz baths, antibiotics). Examination identifies an external fistulous opening with induration and a palpable tract. The surgeon plans a limited operative procedure in an ambulatory surgery center under monitored anesthesia care to incise and excise the superficial fistula tract. The workflow includes preoperative evaluation and consent, marking the tract, administration of local or regional anesthesia (with sedation if needed), incision and curettage or excision of the fistula tract, hemostasis, dressing application, and brief postoperative recovery with discharge instructions for wound care and follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure | Use when a distinct evaluation and management service is provided on the same day as the incision/excision of a fistula (if applicable). |
52 |