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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.

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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.

Service type: Surgical treatment of anal fissure with concurrent anal sphincter dilation
Typical site of service: Ambulatory surgical center or hospital outpatient department

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

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Get alerted when payer policies referencing 46942 are released or updated.

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Billing Code Overview

Service type: Surgical treatment of anal fissure with concurrent anal sphincter dilation
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.
`22`	Increased procedural services	When work required is substantially greater than typically required (e.g., extensive scar tissue, complex fissure).
`23`	Unusual anesthesia	When procedure is performed under general anesthesia for medical reasons when normally local/regional would be used.
`26`	Professional component	When only the physician interpretation or professional component is billed separately from technical components.
`50`	Bilateral procedure	If the procedure were performed bilaterally and payer requires a bilateral modifier (rare for anal fissure but included when applicable).
`51`	Multiple procedures	When `46942` is reported with other unrelated procedures on the same day and payer rules require a multiple procedure modifier.
`52`	Reduced services	When the procedure is partially reduced or not completed as planned (e.g., attempted dilation aborted).
`53`	Discontinued procedure	When the procedure is terminated due to extenuating circumstances after anesthesia initiated.
`62`	Two surgeons	When two surgeons work together as primary surgeons performing distinct operative parts.
`66`	Surgical team	When a surgical team approach is used for complex cases requiring multiple providers.
`78`	Return to operating room for related procedure during postoperative period	When the patient returns to the OR for a related complication or revision of the fissure repair during the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	When an unrelated procedure is performed during the global period.
`80`	Assistant surgeon	When an assistant at surgery is required and billed.
`62`	Two surgeons (duplicate row indicates emphasis)	When two surgeons are required to perform distinct portions of the operation.

Taxonomy Code	Specialty	Notes
207P00000X	Colon & Rectal Surgery	Primary specialty that commonly performs fissurectomy and sphincter dilation.
2080P0210X	General Surgery	General surgeons with colorectal interest commonly perform this procedure.
207RH0000X	Proctology	Proctologists or colorectal subspecialists frequently manage chronic anal fissures.
208000000X	Family Medicine	Family physicians with procedural training in anorectal procedures may occasionally perform in office settings.
208D00000X	Gastroenterology	Gastroenterologists may diagnose and sometimes perform office-based anorectal procedures, though less commonly the surgical fissurectomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.0`	Anal fissure, acute	Represents acute fissure treated with fissurectomy and dilation when conservative care fails.
`K60.1`	Anal fissure, chronic	Chronic fissures often require surgical fissurectomy and sphincter dilation for definitive treatment.
`K60.2`	Anal fissure, unspecified	Used when laterality or acuity not specified but procedure addresses fissure.
`K62.5`	Rectal tenesmus	Symptom that may accompany fissure and prompt intervention.
`K64.8`	Other specified hemorrhoidal disease	Coexisting hemorrhoidal disease may be addressed in the same encounter or contribute to symptoms.
`R10.4`	Other and unspecified abdominal pain	Non-specific pain presentation that may lead to anorectal evaluation and treatment.
`R19.5`	Other fecal abnormalities (e.g., difficulty passing stool)	Stool passage difficulty relates to sphincter hypertonicity and fissure formation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46060`	Excision of lesion of anal canal (eg, polyp, condyloma)	May be performed in the same session for concurrent anal lesions requiring excision.
`46610`	Dilatation of anus (without internal sphincterotomy)	Alternative or adjunct procedure when only dilation is performed; shares technique and indications.
`43235`	Esophagogastroduodenoscopy, diagnostic, flexible, transoral — diagnostic (note: not directly related to anorectal procedures)	Data not available in the input.
`45380`	Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed	May be performed preoperatively to evaluate distal colon/rectum or rule out other pathology in symptomatic patients.
`54050`	Destruction of perianal lesion (eg, thrombosed hemorrhoid)	May be performed for concurrent perianal pathology during the same operative encounter.

CPT 46900: Chemical Destruction of Anal Lesion

CPT-46910-ANAL-LESION-DESTRUCTION-CAUTERY

CPT 46910: Destruction of Anal Lesion by Thermal Cautery

CPT-46916-ANAL-LESION-DESTRUCTION-CRYOTHERAPY

CPT 46916: Destruction of Anal Lesion Using Cryotherapy

CPT-46917-ANAL-LESION-DESTRUCTION-LASER

CPT 46917: Laser Destruction of Anal Lesion

CPT-46922-ANAL-LESION-DESTRUCTION-EXCISION

CPT 46922: Excision or Destruction of Anal Lesion

CPT-46924-EXTENSIVE-ANAL-LESION-DESTRUCTION

CPT 46924: Extensive Destruction of Anal Lesion

CPT-46930-INTERNAL-HEMORRHOID-THERMAL-DESTRUCTION

CPT 46930: Destruction of Internal Hemorrhoids by Thermal Techniques

CPT-46940-ANAL-FISSURE-OTOMY-AND-SPHINCTER-DILATION

CPT 46940: Anal Fissure Removal with Anal Sphincter Dilation

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

CPT 46945: Hemorrhoidectomy for Single Hemorrhoid or Group

CPT-46946-EXCISION-MULTIPLE-HEMORRHOIDS-NON-RUBBER-BAND-TECHNIQUES

CPT 46946: Excision of Two or More Hemorrhoids (Non-Rubber Band)

Showing 1–10 of 12

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

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.
`22`	Increased procedural services	When work required is substantially greater than typically required (e.g., extensive scar tissue, complex fissure).
`23`	Unusual anesthesia	When procedure is performed under general anesthesia for medical reasons when normally local/regional would be used.
`26`	Professional component	When only the physician interpretation or professional component is billed separately from technical components.
`50`	Bilateral procedure	If the procedure were performed bilaterally and payer requires a bilateral modifier (rare for anal fissure but included when applicable).
`51`	Multiple procedures	When `46942` is reported with other unrelated procedures on the same day and payer rules require a multiple procedure modifier.
`52`	Reduced services	When the procedure is partially reduced or not completed as planned (e.g., attempted dilation aborted).
`53`	Discontinued procedure	When the procedure is terminated due to extenuating circumstances after anesthesia initiated.
`62`	Two surgeons	When two surgeons work together as primary surgeons performing distinct operative parts.
`66`	Surgical team	When a surgical team approach is used for complex cases requiring multiple providers.
`78`	Return to operating room for related procedure during postoperative period	When the patient returns to the OR for a related complication or revision of the fissure repair during the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	When an unrelated procedure is performed during the global period.
`80`	Assistant surgeon	When an assistant at surgery is required and billed.
`62`	Two surgeons (duplicate row indicates emphasis)	When two surgeons are required to perform distinct portions of the operation.

Taxonomy Code	Specialty	Notes
207P00000X	Colon & Rectal Surgery	Primary specialty that commonly performs fissurectomy and sphincter dilation.
2080P0210X	General Surgery	General surgeons with colorectal interest commonly perform this procedure.
207RH0000X	Proctology	Proctologists or colorectal subspecialists frequently manage chronic anal fissures.
208000000X	Family Medicine	Family physicians with procedural training in anorectal procedures may occasionally perform in office settings.
208D00000X	Gastroenterology	Gastroenterologists may diagnose and sometimes perform office-based anorectal procedures, though less commonly the surgical fissurectomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.0`	Anal fissure, acute	Represents acute fissure treated with fissurectomy and dilation when conservative care fails.
`K60.1`	Anal fissure, chronic	Chronic fissures often require surgical fissurectomy and sphincter dilation for definitive treatment.
`K60.2`	Anal fissure, unspecified	Used when laterality or acuity not specified but procedure addresses fissure.
`K62.5`	Rectal tenesmus	Symptom that may accompany fissure and prompt intervention.
`K64.8`	Other specified hemorrhoidal disease	Coexisting hemorrhoidal disease may be addressed in the same encounter or contribute to symptoms.
`R10.4`	Other and unspecified abdominal pain	Non-specific pain presentation that may lead to anorectal evaluation and treatment.
`R19.5`	Other fecal abnormalities (e.g., difficulty passing stool)	Stool passage difficulty relates to sphincter hypertonicity and fissure formation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46060`	Excision of lesion of anal canal (eg, polyp, condyloma)	May be performed in the same session for concurrent anal lesions requiring excision.
`46610`	Dilatation of anus (without internal sphincterotomy)	Alternative or adjunct procedure when only dilation is performed; shares technique and indications.
`43235`	Esophagogastroduodenoscopy, diagnostic, flexible, transoral — diagnostic (note: not directly related to anorectal procedures)	Data not available in the input.
`45380`	Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed	May be performed preoperatively to evaluate distal colon/rectum or rule out other pathology in symptomatic patients.
`54050`	Destruction of perianal lesion (eg, thrombosed hemorrhoid)	May be performed for concurrent perianal pathology during the same operative encounter.

CPT 46900: Chemical Destruction of Anal Lesion

CPT-46910-ANAL-LESION-DESTRUCTION-CAUTERY

CPT 46910: Destruction of Anal Lesion by Thermal Cautery

CPT-46916-ANAL-LESION-DESTRUCTION-CRYOTHERAPY

CPT 46916: Destruction of Anal Lesion Using Cryotherapy

CPT-46917-ANAL-LESION-DESTRUCTION-LASER

CPT 46917: Laser Destruction of Anal Lesion

CPT-46922-ANAL-LESION-DESTRUCTION-EXCISION

CPT 46922: Excision or Destruction of Anal Lesion

CPT-46924-EXTENSIVE-ANAL-LESION-DESTRUCTION

CPT 46924: Extensive Destruction of Anal Lesion

CPT-46930-INTERNAL-HEMORRHOID-THERMAL-DESTRUCTION

CPT 46930: Destruction of Internal Hemorrhoids by Thermal Techniques

CPT-46940-ANAL-FISSURE-OTOMY-AND-SPHINCTER-DILATION

CPT 46940: Anal Fissure Removal with Anal Sphincter Dilation

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

CPT 46945: Hemorrhoidectomy for Single Hemorrhoid or Group

CPT-46946-EXCISION-MULTIPLE-HEMORRHOIDS-NON-RUBBER-BAND-TECHNIQUES

CPT 46946: Excision of Two or More Hemorrhoids (Non-Rubber Band)

Showing 1–10 of 12

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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

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Billing Code Overview

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

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References