Summary & Overview
CPT 46716: Repair of Low Imperforate or Malformed Anus
CPT code 46716 denotes surgical correction of a low imperforate or malformed anus, including closure of anoperineal or anovestibular fistula, creation of a new anal opening, and repositioning of the rectal pouch. This procedure addresses congenital anorectal malformations that can have significant implications for bowel function, infection risk, and long-term quality of life. Nationally, such reconstructive pelvic procedures are clinically significant because they involve specialized pediatric and colorectal surgical expertise and can drive utilization in tertiary care centers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, typical sites of service and service classification, and the types of benchmarks and policy issues commonly associated with complex surgical reconstruction codes. The publication outlines reimbursement benchmarking approaches, common modifier usage patterns (listed separately), and considerations payers and providers monitor for authorization and coverage decisions.
This summary provides a concise guide to what CPT code 46716 represents, why it matters to payers and health systems, and the topics covered in the full publication, including national benchmarking, policy implications, and coding context for surgical repair of anorectal malformations.
Billing Code Overview
CPT code 46716 describes a surgical repair for a low imperforate anus or malformed anus. The procedure includes closure of an anoperineal or anovestibular fistula, creation of a new anal opening, and repositioning of the rectal pouch into the anal opening.
Service type: Surgical repair of congenital anorectal malformation
Typical site of service: Inpatient or outpatient surgical setting (operating room)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A realistic patient scenario involves a neonate or infant born with an imperforate anus or a low malformation of the anorectal region presenting with an anoperineal or anovestibular fistula and inability to pass stool normally. The surgical team—typically pediatric surgery with neonatal anesthesiology support—evaluates the infant with a focused physical exam and abdominal/ pelvic imaging as needed to confirm the location of the rectal pouch and the presence of a fistula. Preoperative preparation includes bowel management if previously diverted, routine neonatal labs, and anesthesia assessment. In the operating room, the surgeon performs a perineal repair: closure of the fistula, creation of a patent anal opening, and mobilization/repositioning of the rectal pouch into the neorectum with layered soft-tissue reconstruction. Postoperative care occurs in a pediatric recovery or neonatal intensive care setting with monitoring for wound integrity, stool passage, infection, and urinary function. Follow-up includes wound checks, stooling assessment, potential dilations, and long-term anorectal function monitoring by pediatric surgery and colorectal specialty clinics.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no specific modifier applies and routine reporting is required |