Summary & Overview
CPT 46742: Repair of High Imperforate Anus with Fistula
CPT code 46742 denotes a complex surgical procedure for repair of a high imperforate anus with a rectourethral or rectovaginal fistula, performed via combined transabdominal and sacroperineal approaches. This code captures care for a rare but clinically significant congenital anorectal malformation that typically requires multidisciplinary surgical management and inpatient operative care. Nationally, accurate coding of this procedure matters for surgical quality reporting, resource planning, and appropriate reimbursement for complex pediatric and reconstructive colorectal surgery.
Key payers referenced 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 settings where the service is delivered, and the common modifiers associated with surgical billing for this code. The publication provides benchmark guidance on coding practice patterns, notes on documentation elements relevant to claim adjudication, and summaries of payer coverage considerations where available. Data not available in the input is clearly identified; the piece does not offer clinical recommendations but focuses on coding, billing, and administrative context to support revenue integrity and policy review.
Billing Code Overview
CPT code 46742 describes a combined transabdominal and sacroperineal repair of a high imperforate anus with an associated rectourethral or rectovaginal fistula. The procedure addresses a congenital malformation in which the rectal opening is absent and a fistulous connection to the genitourinary or vaginal tract is present.
Service type: Surgical repair of congenital anorectal malformation
Typical site of service: Inpatient hospital surgical setting, often performed in an operating room with possible postoperative inpatient care.
Clinical & Coding Specifications
Clinical Context
A full-term male neonate is born with absent anal opening and stool passing through the urethra. Physical exam confirms a high imperforate anus with a suspected rectourethral fistula. The infant undergoes diagnostic imaging including abdominal and pelvic ultrasound and a contrast distal colostogram to delineate the fistula and level of the rectal pouch. The surgical team (pediatric surgery and pediatric urology) schedules a combined transabdominal and sacroperineal repair under general anesthesia to mobilize the rectum, ligate and repair the fistula, and create a normal neo-anus with perineal reconstruction. Typical intraoperative workflow includes laparotomy or laparoscopy to mobilize the rectum and inspect pelvic anatomy, identification and separation of the fistulous tract, perineal dissection via a sacroperineal approach to pull-through the rectum and perform anorectoplasty, and multilayer repair. Postoperative care includes monitoring in a neonatal intensive care unit or pediatric surgical recovery area, pain control, antibiotics as indicated, wound and stoma care if a diverting colostomy exists, and follow-up imaging or examinations to confirm patency and continence development over time.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no additional informational modifier applies to the claim |