Summary & Overview
CPT 46712: Ileoanal Pouch Fistula/Sinus Repair, Pouch Advancement
CPT code 46712 represents surgical repair of an ileoanal pouch fistula or sinus via pouch advancement through the perineum and abdomen. The procedure is clinically important as a reconstructive option for patients who have undergone proctocolectomy with ileoanal pouch construction for diseases such as ulcerative colitis, Crohn's disease, colorectal cancer, or injury. Nationally, this code captures a complex pelvic and abdominal operation that can impact resource use, surgical outcomes, and post-operative care pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, where the service is typically delivered, and common billing considerations tied to this surgical procedure. The publication highlights benchmarks relevant to utilization and reimbursement patterns, summarizes recent policy or coding guidance affecting claim adjudication, and clarifies typical service-line implications for hospitals and surgical practices.
This summary is intended for a national audience of clinicians, coding professionals, and health policy analysts seeking a clear framing of CPT code 46712 — what it denotes clinically, which payers commonly contract for it, and the topics to review further when evaluating coding, billing, and coverage for ileoanal pouch fistula repair.
Billing Code Overview
CPT code 46712 describes surgical repair of an ileoanal pouch fistula or sinus by pouch advancement performed through the perineum and abdomen. This procedure typically addresses complications in patients who have had their large intestine removed and an ileoanal pouch constructed, often for conditions such as ulcerative colitis, Crohn's disease, colorectal cancer, or traumatic injury.
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Service type: Surgical repair of ileoanal pouch fistula/sinus; reconstructive pouch advancement procedure
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Typical site of service: Inpatient or outpatient hospital surgical setting, including operating room procedures involving perineal and abdominal access
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Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with a history of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) for ulcerative colitis presents with persistent perineal drainage and pelvic pain. Imaging and endoscopic evaluation identify a fistula tract between the ileoanal pouch and perineum with a pouch sinus. The colorectal surgery team schedules operative repair under general anesthesia: an abdominal and perineal approach to mobilize the ileal pouch, excise the fistulous tract, and advance the pouch to re-establish a tension-free anastomosis. The typical clinical workflow includes preoperative bowel preparation and antibiotics, intraoperative cystoscopy or flexible pouchoscopy to assess pouch integrity, coordinated abdominal and perineal exposure, repair with possible diversion review (if present), and postoperative monitoring for infection, anastomotic integrity, and bowel function. Typical postoperative care includes inpatient pain control, wound care, prophylactic antibiotics as indicated, and follow-up pouch evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work than usual (extensive adhesiolysis, prolonged operative time). |
23 |