Summary & Overview
CPT 46744: Repair of Cloacal Anomaly via Sacroperineal Approach
CPT code 46744 represents a surgical procedure to repair a cloacal anomaly, correcting combined anorectal and vaginal malformations in females and addressing any associated urethral wall injury through a sacroperineal approach. This complex reconstructive operation is clinically significant due to its role in restoring anatomy and function, reducing long-term morbidity, and often requiring multidisciplinary perioperative care. Nationally, accurate coding for this procedure affects hospital resource planning, surgical quality measurement, and appropriate payer reimbursement for high-complexity pediatric and adult reconstructive services. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context of CPT code 46744, typical sites of service, common modifier use, and the types of documentation and coding considerations relevant to billing this procedure. The publication also outlines benchmark usage patterns, where available, and summarizes policy and coverage considerations that influence claim adjudication. Data not available in the input is indicated where applicable, and readers will find guidance on navigating payer interactions and coding documentation to support accurate claims for this specialized surgical service.
Billing Code Overview
CPT code 46744 describes a surgical repair of a cloacal anomaly, addressing a combined female anorectal and vaginal defect or malformation. The procedure includes repair of any urethral wall injury and is performed via a sacroperineal approach.
Service type: Surgical — Pediatric/Colorectal/Genitourinary Reconstruction
Typical site of service: Hospital operating room (inpatient or outpatient surgical setting depending on clinical indication and patient status).
Clinical & Coding Specifications
Clinical Context
A typical patient is a newborn or infant female diagnosed with a cloacal malformation identified at birth or shortly after due to absent or abnormal anal opening, combined genitourinary and anorectal anomalies, or abnormal perineal anatomy. Presentation often includes meconium passage through a common urogenital channel, urinary tract dilation or infection, and inability to pass stool normally. Initial evaluation includes physical exam, abdominal and pelvic ultrasound, pelvic MRI, and possibly contrast studies to delineate the length of the common channel and associated renal or spinal anomalies. The surgical team—pediatric colorectal surgeon and pediatric urologist—plans definitive reconstruction after initial stabilization, bowel management, and infection control.
The procedure described by 46744 is a sacroperineal approach to repair the cloacal anomaly, reconstruct the anorectal canal and vaginal anatomy, and repair any urethral wall injury. Typical workflow includes preoperative imaging and bowel preparation, multidisciplinary operative planning, anesthesia for an infant or child, intraoperative cystoscopy or vaginoscopy as needed, sacroperineal dissection and reconstruction, and postoperative monitoring in a pediatric surgical unit with attention to urine output, wound healing, and bowel function. Follow-up includes urology and colorectal assessments, imaging as indicated, and long-term bowel and urinary continence management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |