Summary & Overview
CPT 46707: Anorectal Fistula Repair with Tissue Flap
CPT code 46707 represents surgical repair of an anorectal fistula using a tissue flap to close an abnormal opening between the anus and rectum. This reconstructive procedure is clinically significant because anorectal fistulas can cause persistent infection, pain, and fecal leakage, and repair often requires specialized surgical technique. Nationally, this code is used across inpatient and outpatient surgical settings for patients with fistulas from prior surgery, congenital anomalies, trauma, infection, or other etiologies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for the procedure, typical sites of service, common billing modifiers associated with surgical care, and where available, payer-specific coverage approaches and reimbursement benchmarks. The publication summarizes policy considerations for surgical coding and documentation, outlines typical service lines and relevant clinical indications, and flags areas where authorization or medical necessity documentation is frequently required.
The piece is intended to inform coders, billing managers, and policy analysts about how CPT code 46707 is categorized and used, what clinical scenarios prompt its use, and which payers commonly process claims for this service. Data not available in the input are explicitly noted where applicable.
Billing Code Overview
CPT code 46707 describes a surgical repair of an anorectal fistula using a tissue flap to close an abnormal opening between the anus and rectum. This procedure addresses fistulas that may arise after prior abdominal surgery, from congenital causes, trauma, infection, or other conditions.
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Service type: Surgical repair of anorectal fistula using tissue flap (reconstructive anorectal surgery)
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 46-year-old patient presents with persistent drainage and recurrent perianal irritation three months after a complicated hemorrhoidectomy. Examination and MRI fistulography confirm a transsphincteric anorectal fistula with an external opening lateral to the anal verge. The colorectal surgeon schedules a repair using a tissue flap closure to close the tract and preserve sphincter function. The patient is admitted to an ambulatory surgery center and undergoes preoperative evaluation, regional or general anesthesia, intraoperative identification and curettage of the fistula tract, creation or mobilization of a mucosal advancement or V-Y flap (or other tissue flap), flap advancement to close the internal opening, layered closure, and dressing. Postoperative workflow includes recovery room monitoring, discharge instructions for wound care, analgesia, stool softeners, and outpatient follow-up within 1–2 weeks to assess healing and monitor for recurrence or infection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use as the default when no special circumstance applies |
11 | Normal, uncomplicated service | Use when procedure is routine without unusual circumstances |