Summary & Overview
CPT 46760: Sphincteroplasty with Muscle Transplant
CPT code 46760 codes for sphincteroplasty with muscle transplant — a reconstructive surgical procedure to repair the anal sphincter in adults with sphincter injury or fecal incontinence. Nationally, this code denotes a specialized colorectal/pelvic surgery with implications for surgical access, post-operative care, and benefit coverage for patients with severe sphincter dysfunction. The procedure is typically performed in a hospital operating room or ambulatory surgical center by colorectal or general surgeons.
Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise synthesis of clinical context for 46760, common billing considerations, and what to expect in payer coverage patterns. The report summarizes available benchmarks, outlines policy and medical necessity themes that commonly influence authorization and coverage decisions, and highlights coding and documentation elements relevant to surgical reconstructive services. Clinical implications, typical sites of service, and procedural intent are described to inform clinicians, coders, and policy analysts. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 46760 describes a sphincteroplasty with muscle transplant in an adult patient. The procedure reconstructs the anal sphincter by transplanting muscle tissue to repair sphincter damage, typically performed for fecal incontinence or injury to the anal canal.
Service type: Surgical — reconstructive pelvic/colorectal procedure
Typical site of service: Hospital operating room or ambulatory surgical center, performed by colorectal or general surgeons experienced in pelvic reconstructive techniques.
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents with progressive fecal incontinence and a history of obstetric or traumatic injury to the perineum. Conservative measures including bowel regimen optimization, pelvic floor physical therapy, and injectable bulking agents have failed. The colorectal surgeon evaluates anal sphincter integrity using endoanal ultrasound and manometry and documents a focal external anal sphincter defect with reduced squeeze pressure. The provider schedules an elective sphincteroplasty under general or regional anesthesia. In the operating room, the surgeon debrides scar tissue, mobilizes viable sphincter muscle edges, and performs overlapping or end-to-end repair; a muscle transplant technique may be used when primary repair is not feasible. Postoperative workflow includes short inpatient observation or same-day discharge depending on recovery, pain control, wound care instructions, stool softeners, and scheduled follow-up with anorectal functional testing to assess restoration of continence.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Data not available in the input. | Data not available in the input. |
26 | Data not available in the input. | Data not available in the input. |