Summary & Overview
CPT 46750: Anal Sphincteroplasty, Surgical Reconstruction
CPT code 46750 denotes an anal sphincteroplasty — a reconstructive surgical procedure to repair the anal sphincter for patients with fecal incontinence or prolapse. The code captures a specialized colorectal surgical service that addresses significant quality-of-life issues and can influence surgical utilization, postoperative care pathways, and payer coverage decisions nationally. Common sites of service include inpatient and outpatient operating-room settings where colorectal or general surgeons perform reconstructive pelvic procedures.
Key payers in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical indication for the procedure, the typical service setting, and how CPT code 46750 is positioned within surgical coding and reimbursement frameworks. The publication summarizes benchmarks for utilization and payment trends where available, highlights relevant policy and coverage considerations that affect access to reconstructive sphincter surgery, and outlines the clinical scenarios that commonly generate this code. Data not available in the input will be noted explicitly in relevant sections.
Billing Code Overview
CPT code 46750 describes an anal sphincteroplasty, the surgical reconstruction of the anal sphincter. The procedure is performed to restore sphincter integrity and function in patients with fecal incontinence or rectal prolapse when surgical repair is indicated.
Service Type: Surgical — Pelvic/Colorectal Reconstruction
Typical Site of Service: Operating room in an inpatient or outpatient surgical setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old female with a history of obstetric trauma and chronic fecal incontinence presents to a colorectal surgeon for evaluation after failed conservative management including pelvic floor physical therapy, biofeedback, and sacral neuromodulation. She reports passive soiling and urgency that interferes with activities of daily living. Examination reveals a tender, thinned external anal sphincter with a palpable defect on digital rectal exam. Endoanal ultrasound confirms a focal defect of the external anal sphincter. The clinical workflow includes preoperative evaluation (history, focused exam, anorectal manometry, endoanal ultrasound), perioperative consent and marking, scheduling in an outpatient surgical suite or hospital operating room under general or regional anesthesia, performance of 46750 (anal sphincteroplasty) to reconstruct the external anal sphincter, intraoperative documentation of findings and repair technique, postoperative pain control and wound care instructions, and follow-up for continence assessment and wound healing. Typical site of service is an ambulatory surgery center or hospital operating room. The service type is a surgical reconstructive procedure for fecal incontinence or sphincter disruption.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the sphincteroplasty requires substantially greater work than typical due to extensive dissection, fibrosis, or additional reconstructive steps. |