Summary & Overview
CPT 46275: Intersphincteric Anal Fistula Surgery
CPT code 46275 represents a surgical procedure for treatment of an intersphincteric anal fistula, a tract that passes between the internal sphincter and may extend to the perianal skin. This code captures definitive surgical management of that specific fistula anatomy and is relevant to colorectal surgeons, general surgeons, and procedural billing teams. Nationally, accurate use of this CPT code supports appropriate clinical documentation, claims adjudication, and aggregation of procedure volumes for quality and access monitoring.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise guidance on the clinical context of the procedure, typical service settings, and common billing considerations such as site of service implications and frequently reported modifiers (list provided separately). The publication outlines benchmarks and payer coverage patterns where available, highlights coding and documentation elements that influence reimbursement, and summarizes relevant policy updates and payer nuances that affect claims processing.
This resource is written for a national audience of clinicians, billing professionals, and policy analysts seeking a clear, practical reference for CPT code 46275 and its role in surgical management of intersphincteric anal fistulae.
Billing Code Overview
CPT code 46275 describes a surgical procedure to treat an anal fistula that courses between the internal sphincter and the perianal skin. The procedure addresses an intersphincteric fistula tract, often involving tract identification, drainage of any associated abscess, and definitive repair or seton placement depending on clinical judgment.
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Service type: Anal fistula surgery (surgical repair/drainage of intersphincteric fistula)
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Typical site of service: Ambulatory surgical center or hospital operating room; may also be performed in an outpatient surgical clinic setting when appropriate
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient presents to a colorectal surgery clinic with persistent perianal drainage and intermittent pain. Physical exam and anoscopy confirm an intersphincteric anal fistula that tracks from the internal anal canal to the perianal skin. The surgeon schedules a definitive operative repair under regional or general anesthesia in an ambulatory surgery center or inpatient operating room depending on patient comorbidity and prior interventions. Preoperative workflow includes history and focused exam, informed consent discussing risks (incontinence, recurrent fistula), preoperative antibiotics per institutional protocol, and bowel preparation as indicated. Intraoperative steps typically include examination under anesthesia, probing and delineation of the tract, possible placement of seton if drainage needed, and definitive fistulotomy or advancement flap targeting the intersphincteric tract. Postoperative workflow includes recovery in PACU, discharge with wound care instructions and analgesia, and outpatient follow-up to assess healing and continence.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds typical for the procedure due to extensive dissection or unexpected findings |
23 |