Summary & Overview
CPT 46761: Anal Sphincter Reconstruction with Levator Muscle Flap
CPT code 46761 represents surgical reconstruction of the anal sphincter using a levator muscle flap to cover damaged sphincter muscles. This procedure addresses sphincter injury, fecal incontinence, or failure of prior treatments and is clinically significant for colorectal and pelvic reconstructive services. Nationally, this code is relevant for surgical specialties involved in anorectal repair and for payers managing coverage of complex pelvic surgeries.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and sites of service, plus benchmarks and policy-relevant considerations affecting reimbursement and authorization practices for reconstructive anorectal surgery. The publication summarizes coding context, common modifiers used with this procedure, and practical points for billing and claims submission. It also highlights clinical context for when reconstruction with a levator flap is pursued versus alternative treatments for fecal incontinence or anal sphincter injury.
This national-level brief is intended to inform clinicians, billing professionals, and policy analysts about the clinical purpose of CPT code 46761, payer coverage landscape, and the types of information stakeholders typically review when evaluating claims and coverage for anal sphincter reconstruction.
Billing Code Overview
CPT code 46761 describes a surgical procedure in which the provider reconstructs the anal sphincter of an adult patient by covering damaged anal sphincter muscles with the levator muscle. This operation is performed for injuries to the anal canal, fecal incontinence, or failure of prior treatment.
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Service type: Surgical reconstruction of the anal sphincter (levator muscle flap)
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Typical site of service: Inpatient or outpatient surgical setting, commonly performed in an operating room under general or regional anesthesia
Clinical & Coding Specifications
Clinical Context
An adult patient with significant anal sphincter disruption presents with fecal incontinence after an obstetric tear or traumatic injury to the perineum. Preoperative evaluation includes history and physical exam, anorectal manometry, endoanal ultrasound to define the extent of sphincter defect, and optimization of comorbidities (e.g., diabetes control). The patient is consented for surgical reconstruction under general or regional anesthesia. In the operating room, the surgeon exposes the damaged external and internal sphincter complex, mobilizes adjacent levator muscle tissue, and repositions or advances the levator to cover and reinforce the sphincter repair (levatorplasty). Hemostasis is achieved, and perioperative antibiotics and bowel regimen are ordered. Typical postoperative workflow includes pain management, stool softeners, wound care, pelvic floor rehabilitation, and outpatient follow-up to assess continence recovery and wound healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work required is substantially greater than usual (extensive dissection, repeat reconstruction after prior failed repair). |
23 | Unusual anesthesia | Use when general anesthesia is required for an otherwise normally non-general procedure or when anesthesia is unusually complex.
| Professional component | Use if reporting only the physician professional component separate from a facility technical component (rare for surgery; typically facility bills technical).