Summary & Overview
CPT 46748: Cloacal Anomaly Repair with Vaginal Lengthening
CPT code 46748 represents a major reconstructive surgical procedure to repair cloacal anomalies, addressing combined anorectal and vaginal malformations and any urethral wall injury via a combined abdominal and sacroperineal approach with vaginal lengthening using grafts or pedicle flaps. This is a high-complexity, specialty surgical service commonly performed in tertiary pediatric or adult reconstruction centers and has important implications for surgical authorization, bundled payment considerations, and post-operative care protocols nationally. Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise clinical and billing overview of CPT code 46748, including service context, typical sites of care, common modifiers encountered in claims, and areas where payers commonly focus utilization review and coverage policy. The publication outlines typical documentation elements and clinical indications associated with complex cloacal repair, highlights where policy updates could affect preauthorization and inpatient coding, and identifies gaps where standardized coding guidance or payer policy language is limited. Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, related codes, and detailed payer-specific reimbursement benchmarks.
Billing Code Overview
CPT code 46748 describes a complex surgical repair of a cloacal anomaly that addresses combined anorectal and vaginal defects or malformations with concurrent repair of urethral wall injury. The procedure uses a combined abdominal and sacroperineal approach and includes vaginal lengthening using a graft or pedicle flaps.
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Service type: Major reconstructive pelvic surgery for congenital cloacal anomalies
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Typical site of service: Inpatient hospital operating room or specialized pediatric/adult tertiary surgical center
Clinical & Coding Specifications
Clinical Context
A 6-month-old female infant born with a cloacal malformation is scheduled for definitive reconstructive surgery. Preoperative evaluation includes pediatric surgery, pediatric urology, and pediatric gynecology assessments, imaging with a pelvic MRI and distal colostogram, renal ultrasound to assess the urinary tract, basic labs, and bowel management planning. The operative plan is a combined abdominal and sacroperineal approach to reconstruct the anorectal canal, separate and repair the common urogenital sinus, repair any urethral wall injuries, and lengthen the vagina using grafts or pedicle flaps. Intraoperative steps include abdominal mobilization of the rectum, mobilization of vaginal tissue, creation of a neo-anus via sacroperineal dissection, urethral repair as needed, and vaginal lengthening with graft/pedicle flap. Postoperative care includes monitoring in pediatric surgical recovery or pediatric intensive care as indicated, pain control, catheter management, wound care, bowel regimen, and staged follow-up with possible dilations and urologic monitoring. Typical site of service is an inpatient pediatric tertiary care center with operating room and pediatric intensive care available. Service type: major reconstructive pelvic surgery requiring multidisciplinary surgical teams and inpatient hospitalization.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/placeholder (Not a standard CMS modifier) | Data not typically used for payer reporting; avoid using unless payer-specific instruction requires it. |