Summary & Overview
CPT 46740: Repair of High Imperforate Anus with Rectovaginal/Rectourethral Fistula
CPT code 46740 represents surgical repair of a high imperforate anus with an associated rectourethral or rectovaginal fistula, performed via a perineal or sacroperineal approach. This procedure addresses a congenital anorectal malformation that typically requires specialized pediatric colorectal surgical expertise and inpatient operative care. Nationally, proper coding for this complex reconstructive surgery affects case classification, hospital resource use, and surgical quality measurement for congenital anorectal anomalies.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the common billing considerations tied to this code. The publication outlines benchmarks related to utilization and payment patterns, summarizes relevant policy or coverage considerations affecting access to specialized pediatric surgical care, and highlights coding nuances that commonly arise with high imperforate anus repairs. Where input data are incomplete, the text notes when specific payer policy details or associated diagnosis lists are not available.
This summary is intended for clinicians, coding professionals, and policy analysts seeking a focused overview of CPT code 46740, its clinical significance, and the administrative context around billing and coverage for complex pediatric anorectal reconstruction.
Billing Code Overview
CPT code 46740 describes surgical repair of a high imperforate anus with an associated rectourethral or rectovaginal fistula. The procedure is performed through a perineal or sacroperineal approach to reconstruct the anorectal anatomy and address the fistulous connection.
Service type: Complex pediatric colorectal reconstructive surgery
Typical site of service: Operating room in an inpatient hospital setting, often within pediatric surgery or pediatric colorectal specialty services.
Clinical & Coding Specifications
Clinical Context
A full-term male neonate is born with an imperforate anus identified on newborn exam. The infant has abdominal distention and inability to pass meconium. Imaging (invertogram/contrast studies) and pelvic MRI identify a high-type imperforate anus with a rectourethral fistula. Initial management includes a diverting colostomy performed in the neonatal period. At 3–6 months of age, following growth and evaluation, the pediatric colorectal surgery team plans a definitive pull-through repair via a posterior sagittal or sacroperineal approach to reconstruct the anorectal canal and close the rectourethral fistula. The typical clinical workflow includes preoperative evaluation (anesthesia assessment, baseline labs), intraoperative repair using CPT 46740 for high imperforate anus with rectourethral or rectovaginal fistula, intraoperative urinary catheterization to protect the urinary tract, possible concurrent urologic assistance for fistula repair, postoperative monitoring in a pediatric recovery unit, pain and wound management, and staged colostomy takedown several months later if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple Procedures | When CPT 46740 is billed with additional unrelated procedures during the same operative session. |