Summary & Overview
CPT 46942: Anal Fissure Removal with Anal Sphincter Dilation (Subsequent)
CPT code 46942 represents a subsequent surgical procedure for treatment of an anal fissure that includes removal of fissure tissue by scraping or burning combined with deliberate dilation of the anal sphincter to lower anal canal pressure. This procedure is clinically important for patients with persistent or recurrent fissures after an initial attempt and can affect facility utilization in ambulatory surgical centers and hospital outpatient departments.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines what 46942 covers, the clinical context for when it is used, and how it is billed as a subsequent procedure. Readers will find benchmark guidance on coding and service setting, a concise clinical description to support documentation, and notes on common modifiers and payer coverage patterns where available. Data not provided in the input are noted as unavailable.
This summary is intended for coding professionals, clinical administrators, and policy analysts seeking a clear, national-level overview of the code’s clinical purpose, typical sites of service, and the payer landscape relevant to billing and utilization.
Billing Code Overview
CPT code 46942 describes a procedure in which the provider removes an anal fissure lesion by scraping (debridement) or cauterization (burning) and performs a separate dilation of the anal sphincter to reduce anal canal pressure. This service represents a subsequent procedure after an initial attempt.
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Service type: Surgical treatment of anal fissure with concurrent anal sphincter dilation
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Typical site of service: Ambulatory surgical center or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient proctology or colorectal surgery clinic with persistent anal fissure causing severe pain with bowel movements and occasional minor rectal bleeding despite conservative care (topical nitrates or calcium channel blockers, stool softeners). After initial evaluation including history, anorectal exam, and failed medical therapy, the provider performs a procedure to treat the fissure: a fissurectomy (scraping or excision of chronic fissure tissue) combined with an internal anal sphincter dilation to reduce resting anal canal pressure. The procedure is often performed under local anesthesia with sedation or monitored anesthesia care in an ambulatory surgery center or hospital outpatient setting. Typical workflow: pre-procedure consent and bowel regimen review, intra-procedure exam under anesthesia, fissure debridement or chemical/electrocautery ablation, controlled anal sphincter dilation, hemostasis, and brief recovery with post-procedure pain control and instructions. This code represents a subsequent procedure after an initial attempt to manage the fissure failed or required repeat intervention.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, additional physician service | When the filing provider is the primary surgeon performing the procedure and the service is the routine/expected service. |