CPT® Code 46060

Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, with or without placement of seton

The CPT® Code 46060 refers to the surgical procedure involving the incision and drainage of an ischiorectal or intramural abscess, which may also include a fistulectomy or fistulotomy. An ischiorectal abscess is a localized collection of pus that occurs in the ischiorectal space, a wedge-shaped area situated between the ischial tuberosity and the obturator internus muscle on one side, and the external anal sphincter and levator ani muscle on the other. This type of abscess can be unilateral or may extend posteriorly, potentially forming a horseshoe abscess that encircles the anal region. An intramural abscess, on the other hand, is found within the wall of the anal or rectal tissue. The formation of a fistula, which is an abnormal connection between two epithelial surfaces, typically occurs when an abscess ruptures, leading to the need for surgical intervention. The procedure begins with a digital rectal examination to identify the abscess and the associated fistula tract. A surgical incision is then made to allow for drainage and thorough inspection of the abscess cavity, which may involve breaking up any loculations present. The procedure may conclude with the placement of a drain or packing the incision, followed by the opening or excision of the fistula tract. Additionally, a seton may be placed to facilitate drainage or promote healing through controlled fibrosis, depending on the specific needs of the patient.