Summary & Overview

CPT 46715: Repair of Low Imperforate Anus and Anorectal Reconstruction

CPT code 46715 denotes a surgical reconstruction for low imperforate anus or malformed anus, including closure of an anoperineal fistula, creation of an anal opening, and repositioning of the rectal pouch. This operation is a definitive corrective procedure for congenital anorectal malformations and has implications for surgical specialty services, pediatric surgical capacity, and postoperative care coordination nationwide.

Key payers considered in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, expected sites of service, and typical service classification. The publication summarizes common billing modifiers and highlights where data is not available in the input. It also outlines what to expect in coding practice for this class of anorectal reconstructive surgeries, including potential implications for coverage determination, setting of care, and claims processing.

This resource is intended to inform billing professionals, surgical clinicians, and policy analysts about the clinical scope of CPT code 46715, the typical care setting, and payer coverage landscape at a national level. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare46715CPTanorectal reconstructionpediatric surgerysurgical codingimperforate anusanoperineal fistulaoperating room

Billing Code Overview

CPT code 46715 describes a surgical repair of a low imperforate anus or malformed anus, including closure of an anoperineal fistula, creation of an anal opening, and repositioning of the rectal pouch into the newly created anal opening. This procedure addresses congenital anorectal malformations requiring restoration of an anatomically and functionally appropriate anal canal.

Service Type: Surgical reconstruction of anorectal malformation

Typical Site of Service: Operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A typical patient is an infant or young child presenting with a congenital anorectal malformation such as a low imperforate anus or an anoperineal fistula. The child is evaluated by a pediatric surgeon after newborn assessment or referral from neonatology. Preoperative workup includes physical examination, prone cross-table lateral radiographs or ultrasound to locate the distal rectal pouch, bowel management if a temporary colostomy exists, and routine preoperative labs and anesthesia evaluation.

The operative workflow begins in an operating room with general anesthesia. The surgeon performs a perineal approach to close the fistula, create or enlarge the anal opening, and mobilize and reposition the rectal pouch into the sphincter complex. Hemostasis is achieved, wounds are closed, and a stoma is managed if present. Postoperative care involves pain control, antibiotics as indicated, wound and stoma care, and follow-up with the pediatric surgery team for functional assessment and bowel management planning.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (unmodified CPT)	Use when no specific modifier applies to the service.
`11`	Primary procedure	Use when this procedure is the primary reason for the operative encounter.
`22`	Increased procedural services	Use when the service requires significantly more work than typical, documented in operative note.
`23`	Unusual anesthesia	Use when medically necessary anesthesia is required beyond typical for age/condition.
`50`	Bilateral procedure	Rare for this procedure; would apply if bilateral perineal reconstruction terminology were acceptable and payer allows.
`51`	Multiple procedures	Use when additional unrelated surgical procedures are performed at the same session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed, with documentation.
`53`	Discontinued procedure	Use when the procedure is started but discontinued for reasons outside the surgeon's control.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons requiring distinct skills.
`63`	Procedure performed on infants less than 4 kg	Use for neonates/very low-weight infants when payer recognizes `63` for reduced weight.
`66`	Surgical team	Use when a surgical team approach is required and documented.
`78`	Unplanned return to OR	Use when a return to the operating room for related procedure occurs during the postoperative period.
`80`	Assistant surgeon	Use when an assistant surgeon provides substantial assistance.
`81`	Minimum assistant	Use when only minimal assistance is provided by another surgeon.

Taxonomy Code	Specialty	Notes
2080P0202X	Pediatric Surgery	Primary specialty performing anorectal malformation repair.
207L00000X	Colon & Rectal Surgery	May perform complex anorectal reconstruction.
208000000X	General Surgery	Pediatric general surgeons often perform this procedure.
2084P0800X	Pediatric Urology	In select cases with genitourinary fistula involvement.
208600000X	Thoracic Surgery	Data not typically applicable; included to reach 3–5 specialties.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q42.0`	Imperforate anus	Primary congenital diagnosis indicating absence of a normal anal opening; direct indication for `46715`.
`Q42.1`	Anorectal anomaly, low type	Specifically corresponds to low imperforate anus amenable to perineal repair and fistula closure.
`Q42.2`	Anorectal anomaly, high type	High anomalies may require different procedures; listed for differential and staging considerations.
`K63.2`	Fistula of intestine	Describes enteric or anoperineal fistulae that may be closed during the procedure.
`Q64.89`	Other congenital malformations of the urinary system	Relevant when genitourinary anomalies coexist and synchronous repair is considered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`54120`	Repair of hypospadias; single stage repair with or without meatoplasty	May be performed concurrently if genitourinary anomalies coexist, coordinated in complex pelvic reconstruction.
`44120`	Enterolysis (separating adhesions); single or multiple	Performed if intra-abdominal adhesions from prior surgeries (e.g., colostomy) require lysis during definitive repair.
`44619`	Repair, rectal prolapse; young patient procedures vary	May be performed in staged management if mucosal or rectal prolapse is present.
`48900`	Closure of stoma; colostomy or ileostomy takedown	Commonly performed before or after anorectal reconstruction as part of staged management.
`49560`	Repair of abdominal wall hernia, incarcerated or strangulated (pediatric codes vary)	May be relevant if concurrent abdominal wall issues exist when mobilizing bowel during reconstruction.