Summary & Overview
CPT 46735: Repair of High Imperforate Anus Without Fistula
CPT code 46735 represents a combined transabdominal and sacroperineal repair for a high imperforate anus without a fistula — a complex congenital anorectal malformation requiring multidisciplinary surgical care. Nationally, this code is important because it captures a resource-intensive pediatric surgical procedure that typically requires inpatient operative time, specialized surgical expertise, and postoperative care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service, and procedural scope, plus benchmarking and policy-relevant content where available. The publication summarizes billing considerations tied to service intensity and hospital-based care, highlights common modifiers that payers may encounter on claims, and outlines areas where prior authorization or payer-specific rules often apply.
This report is intended for billing managers, surgical program administrators, and payer policy analysts seeking a concise reference for coding, claims handling, and the clinical setting of 46735. Data not available in the input is noted where applicable; the narrative emphasizes national applicability and operational considerations for hospitals and specialty surgical practices.
Billing Code Overview
CPT code 46735 describes a combined transabdominal and sacroperineal repair of a high imperforate anus without a fistula. The procedure addresses a congenital malformation in which the rectal opening is absent and requires reconstruction using both abdominal and perineal surgical approaches.
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Service type: Surgical repair of congenital anorectal malformation using combined transabdominal and sacroperineal techniques
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Typical site of service: Inpatient hospital setting, often performed in an operating room with pediatric or colorectal surgical teams
Clinical & Coding Specifications
Clinical Context
A full-term newborn female is diagnosed with a high imperforate anus on neonatal examination and abdominal radiography. The infant has no detectable perineal or vestibular fistula on inspection and contrast studies, and stool is not passed through the perineum. The surgical plan includes a staged approach: initial diversion (colostomy) in the neonatal period followed by definitive repair using a combined transabdominal and sacroperineal approach (posterior sagittal and abdominal mobilization) at an appropriate weight and age. Preoperative workup includes abdominal and pelvic imaging, renal ultrasound to check for associated anomalies, cardiac evaluation, and multidisciplinary planning with pediatric surgery, pediatric anesthesia, and pediatric urology as needed. Intraoperatively, the surgeon performs abdominal mobilization of the rectum, sacral/perineal dissection, and reconstruction of the anorectal canal in its correct anatomic position; a protective colostomy may be reversed in a later procedure after healing. Postoperative workflow includes neonatal or pediatric intensive care monitoring, pain management, wound care, evaluation for urinary or neurologic anomalies, and long-term follow-up for bowel function and potential constipation or encopresis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No device — Not generally used for CMS billing; placeholder in some systems | Rarely applicable; include only if required by local payer systems that accept |