CPT 46940 Anal Fissure Dilation Reimbursement | OpenPayer

Summary & Overview

CPT 46940: Anal Fissure Removal with Anal Sphincter Dilation

CPT code 46940 denotes an initial surgical procedure for treatment of an anal fissure that combines removal of fissure tissue by scraping or burning with a distinct dilation of the anal sphincter to lower anal canal pressure. Nationally, this code matters as a discrete operative entry for surgeons and hospitals managing refractory or chronic fissures where nonoperative care has failed, and it informs billing, utilization tracking, and quality assessment for anorectal surgical care.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and payer coverage landscape. The publication outlines benchmarking considerations and policy-relevant points about procedure categorization, coding clarity, and implications for facility billing and ambulatory surgical workflows. It also highlights areas where input data were unavailable and where payers may apply differing prior authorization or coverage criteria.

This summary offers clinicians, coding professionals, and policy analysts a national overview of the code's clinical role and billing context, plus a roadmap of topics addressed in the full publication: utilization benchmarks, payer policy variations, and operational impacts on ambulatory surgical settings.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 46940anal fissureanorectal surgerysphincter dilationambulatory surgerysurgical codingprocedure codingbilling compliance

Billing Code Overview

CPT code 46940 describes an initial procedural intervention for an anal fissure in which the provider removes tissue by scraping or cauterization and performs a separate dilation of the anal sphincter to reduce anal canal pressure. This procedure is a surgical treatment aimed at resolving a chronic or refractory fissure and addressing sphincter hypertonicity.

Service type: Surgical anorectal procedure
Typical site of service: Ambulatory surgery center or hospital outpatient department (procedure performed in an operative setting)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 38-year-old patient presents to the outpatient colorectal surgery clinic with several weeks of severe, sharp anal pain and bright red bleeding with bowel movements. Conservative measures (topical nitroglycerin, stool softeners, sitz baths) were attempted without durable symptom relief. Examination identifies a chronic posterior midline anal fissure with a sentinel tag and increased resting anal sphincter tone. The surgeon schedules an in-office or ambulatory procedure for fissure management.

On the day of service, the patient is prepped in the procedure room or ambulatory surgery center. Local anesthesia with possible minimal sedation is administered. The provider performs anal canal dilation to reduce sphincter pressure and then treats the fissure by internal sphincterotomy or topical chemical cauterization and excision/curretage of the fissure edges as clinically indicated. Hemostasis is confirmed and the patient receives post-procedure instructions regarding wound care, stool softeners, pain control, and follow-up. The initial procedure is documented with operative findings, dilation performed, method of fissure treatment, anesthesia, and estimated blood loss if applicable.

Typical site of service: outpatient procedure room, ambulatory surgery center, or hospital outpatient department.

Typical service type: surgical treatment of anal fissure with anal sphincter dilation representing an initial operative encounter coded with 46940.

Coding Specifications

Modifier	Description	When to Use

CPT 46924: Extensive Destruction of Anal Lesion

CPT-46948-ULTRASOUND-GUIDED-HEMORRHOIDAL-DEVASCULARIZATION-MUCOPEXY

CPT 46948: Ultrasound-Guided Hemorrhoidal Devascularization with Mucopexy

CPT-46947-HEMORRHOIDECTOMY-STAPLED-HEMORRHOIDOPEXY

CPT 46947: Stapled Hemorrhoidopexy (Hemorrhoidectomy with Repositioning)

CPT-46945-HEMORRHOIDECTOMY-SINGLE-HEMORRHOID-EXCISION-NON-RUBBER-BAND

CPT 46945: Hemorrhoidectomy for Single Hemorrhoid or Group

CPT-46916-ANAL-LESION-DESTRUCTION-CRYOTHERAPY

CPT 46916: Destruction of Anal Lesion Using Cryotherapy

CPT-46922-ANAL-LESION-DESTRUCTION-EXCISION

CPT 46922: Excision or Destruction of Anal Lesion

CPT-46900-CHEMICAL-DESTRUCTION-ANAL-LESION

CPT 46900: Chemical Destruction of Anal Lesion

CPT-46930-INTERNAL-HEMORRHOID-THERMAL-DESTRUCTION

CPT 46930: Destruction of Internal Hemorrhoids by Thermal Techniques

CPT-46910-ANAL-LESION-DESTRUCTION-CAUTERY

CPT 46910: Destruction of Anal Lesion by Thermal Cautery

CPT-46942-ANAL-FISSURE-DEBRIDEMENT-AND-SPHINCTER-DILATION-SUBSEQUENT

CPT 46942: Anal Fissure Removal with Anal Sphincter Dilation (Subsequent)

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Taxonomy Code	Specialty	Notes
208600000X	Colon & Rectal Surgery	Primary specialty performing anal fissure procedures and sphincter dilation.
207P00000X	General Surgery	General surgeons in outpatient or ambulatory settings commonly perform `46940`.
207K00000X	Gastroenterology	Gastroenterologists may perform anorectal procedures in select ambulatory settings.
363L00000X	Family Medicine	Family physicians with procedural training may perform in-office treatment for fissures in some practices.
208800000X	Urology	Urologists occasionally manage anorectal conditions when scope overlaps in specific practice settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.2`	Anal fissure, chronic	Most directly indicates a chronic anal fissure treated with dilation and fissure procedure.
`K60.0`	Anal fissure, acute	Indicates an acute fissure; may lead to early procedural intervention if conservative care fails.
`K60.1`	Anal fissure, recurrent	Documents fissures that recur after prior treatment and may prompt surgical management.
`K62.5`	Hemorrhage of anus and rectum	Relevant when fissure presents with bleeding prompting procedural evaluation and treatment.
`K61.0`	Anal abscess	May coexist or complicate fissure management and require drainage prior to fissure repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46930`	Incision and drainage, perirectal abscess; simple	Performed when a perirectal abscess is present or discovered and requires drainage prior to or instead of fissure repair.
`46040`	Repair of complex rectal or perianal fistula; fistulotomy and/or seton placement	Associated when a chronic fissure is accompanied by fistula disease; alternative or additional anorectal surgical management.
`45378`	Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	May be performed preoperatively for evaluation of lower GI bleeding or other symptoms before definitive anorectal procedure.
`99152`	Moderate sedation services provided by the same physician performing the procedure; initial 15 minutes	Billed when moderate sedation is provided by the same physician during in-office or ambulatory anorectal procedures.
`99024`	Postoperative follow-up visit, after discharge from hospital, or on same day during global period	Used to report significant postoperative visits related to `46940` when appropriate per payer rules.

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