Summary & Overview
CPT 46746: Repair of Cloacal Anomaly with Abdominal and Sacroperineal Approach
CPT code 46746 denotes a complex reconstructive procedure for cloacal anomalies in female patients, combining abdominal and sacroperineal approaches to repair anorectal and vaginal malformations and any urethral wall injury. This highly specialized surgery is performed in hospital operating rooms, frequently at tertiary pediatric or pelvic reconstruction centers. Nationally, accurate coding for such procedures matters for clinical documentation, resource allocation, and ensuring appropriate surgical care pathways for congenital pelvic malformations.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for 46746, typical sites of service, and the implications for hospital-based surgical services. The publication provides benchmarks where available, highlights relevant policy and coverage considerations that affect access to specialized reconstructive surgery, and summarizes coding characteristics important for billing integrity and claims processing. Data not available in the input for specific payer reimbursement rates, associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable. The content is intended for a national audience of clinicians, coding professionals, and health policy analysts seeking concise, practical information about this CPT surgical code.
Billing Code Overview
CPT code 46746 describes a surgical repair of a cloacal anomaly in female patients. The procedure addresses combined anorectal and vaginal defects or malformations and includes repair of any injury to the urethral wall. The operative technique uses both an abdominal approach and a sacroperineal approach to reconstruct the anatomy.
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Service type: Complex reconstructive pediatric/adolescent pelvic surgery combining abdominal and perineal approaches
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Typical site of service: Hospital operating room, often within tertiary pediatric or specialized pelvic reconstruction centers
Clinical & Coding Specifications
Clinical Context
A neonate or infant with a cloacal malformation presents for definitive reconstruction. Typical presentation includes a newborn female with a common channel where the rectum, vagina, and urethra converge, often identified at birth due to abnormal perineal anatomy, inability to pass stool, or associated urinary tract drainage abnormalities. Preoperative workup includes pelvic and abdominal imaging (ultrasound, MRI), cystoscopy, and contrast studies to delineate anatomy and associated anomalies (spinal, renal). Multidisciplinary coordination occurs among pediatric colorectal surgery, pediatric urology, and pediatric gynecology. The procedure is performed in an operating room under general anesthesia, combining an abdominal approach (to mobilize rectum and inspect pelvic structures) with a sacroperineal approach (for perineal reconstruction and creation of separate rectal and vaginal canals). Intraoperative steps commonly include urethral wall repair if injured, mobilization and repositioning of the rectum, creation or reconstruction of the vagina, and layered perineal closure. Postoperative care includes monitoring in a pediatric surgical recovery or pediatric intensive care setting, urinary catheter management, pain control, wound care, and planned follow-up for bowel and urinary function and potential staged procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (unmodified procedure) | Use when no additional reporting modifiers apply to the service. |