Summary & Overview
CPT 46751: Pediatric Anal Sphincter Reconstruction
CPT code 46751 denotes pediatric anal sphincter reconstruction performed to repair defects or tears of the anal sphincter in children with incontinence or prolapse. The code captures a focused reconstructive surgery that addresses significant functional and quality-of-life issues in affected pediatric patients. Nationally, this code is relevant to surgical practice patterns, pediatric specialty workflows, and coverage determinations for reconstructive anorectal procedures.
Key payers included in the scope of this publication are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 46751, typical sites of service, common billing modifiers, and the payer landscape relevant to billing and coverage. The publication also highlights benchmarks and policy considerations that commonly influence authorization and claims processing for pediatric reconstructive anorectal surgery.
This analysis is written for a national audience and aims to clarify what CPT code 46751 represents, outline the clinical scenarios that prompt its use, and summarize the payer environment and administrative issues that providers and billing professionals should expect when submitting claims for this pediatric surgical service. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 46751 describes surgical reconstruction of the anal sphincter in a child. The procedure is performed to repair a defect or tear in the muscular covering of the anal canal in pediatric patients presenting with incontinence or prolapse.
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Service type: Pediatric reconstructive anal sphincter surgery
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Typical site of service: Operating room or ambulatory surgical center, with inpatient or outpatient pediatric surgical settings depending on clinical complexity and patient needs.
Clinical & Coding Specifications
Clinical Context
A typical patient is a pediatric patient (infant to adolescent) presenting with fecal incontinence, persistent rectal prolapse, or congenital or traumatic disruption of the external anal sphincter. The child is evaluated by a pediatric colorectal surgeon with history, physical exam, and anorectal manometry or imaging as indicated. Conservative management (bowel regimen, biofeedback, or stool softeners) is attempted when appropriate. When sphincter tear, significant anatomic defect, or persistent prolapse causes functional impairment, the surgeon plans an operative repair under general anesthesia. The procedure involves exposure of the sphincter complex, identification of muscle edges, and reconstruction/reapproximation of the external anal sphincter to restore continence and anatomic integrity. Typical perioperative workflow includes preoperative evaluation, anesthesia clearance, operative repair in an operating room or ambulatory surgical center, postoperative recovery with pain control and stool regimen, and outpatient follow-up for wound check and functional assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard identification | Use as the default when no other modifier applies. |
22 |