Summary & Overview
CPT 46710: Ileoanal Pouch Fistula or Sinus Repair by Pouch Advancement
CPT code 46710 denotes surgical repair of an ileoanal pouch fistula or sinus via pouch advancement through the perineum. This targeted procedure is performed for patients who have undergone ileoanal pouch construction after colectomy for conditions such as ulcerative colitis, Crohn's disease, colon cancer, or injury. Nationally, this code captures complex pelvic reconstructive surgery with implications for surgical quality, post-operative outcomes, and payer coverage policies.
Key payers commonly involved in coverage and reimbursement for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context and service setting for 46710, and an outline of the payer mix addressed in the publication. The report provides benchmarks and comparative guidance on coding intent, typical sites of service, and the clinical scenarios that generate use of this code. Where specific payer policies, modifier utilization, or diagnosis mappings are not provided in the input, the publication notes that the data are not available in the input and focuses on the clinical and coding definition of the service instead.
This summary is intended for health plan analysts, surgical billing teams, and policy stakeholders seeking a clear national-level description of CPT code 46710 and the clinical circumstances under which it is billed.
Billing Code Overview
CPT code 46710 describes the repair of an ileoanal pouch fistula or sinus by pouch advancement through the perineum. This procedure addresses complications of an ileoanal pouch, which is commonly constructed after removal of the large intestine for conditions such as ulcerative colitis, Crohn's disease, colon cancer, or traumatic injury.
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Service type: Surgical repair of ileoanal pouch fistula or sinus via perineal pouch advancement
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with a history of restorative proctocolectomy and ileoanal pouch (J-pouch) for ulcerative colitis presents with persistent perineal drainage and pelvic pain. Examination and imaging (contrast pouchogram or pelvic MRI) identify a fistula tract from the ileoanal pouch to the perineum. The surgical team elects to perform pouch advancement through the perineum to excise the fistula/sinus and re-create a secure pouch-perineal anastomosis.
The clinical workflow includes preoperative evaluation (history, focused GI and surgical exam, laboratory studies, bowel prep as indicated), informed consent, anesthesia evaluation (general anesthesia), operative procedure in an operating room or ambulatory surgical center equipped for major colorectal surgery, intraoperative monitoring and possible diversion decisions, postoperative recovery with inpatient observation typically 1–3 days depending on complexity, wound care, and follow-up imaging or endoscopic assessment as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and effort significantly exceed typical for 46710 due to extensive dissection or unexpected intraoperative complexity. |