CPT® Code 46275

The CPT® Code 46275 refers to the surgical treatment of an anal fistula, specifically through intersphincteric fistulectomy or fistulotomy. An anal fistula is defined as an abnormal connection between two epithelial surfaces, typically involving the anal canal and the skin surrounding the anus. This condition often arises from an infection in the anal glands, leading to the formation of a tract that can cause discomfort and other complications. During the procedure, a probe or suture may be utilized to navigate through the external opening of the fistula tract to identify the internal opening. The surgical approach involves either incising and opening the fistula tract (fistulotomy) to facilitate healing from the inside out or excising the entire fistula tract (fistulectomy). It is important to differentiate between types of anal fistulas, as the coding varies based on their anatomical location. For instance, CPT® Code 46270 is designated for subcutaneous anal fistulas, while CPT® Code 46280 is used for transsphincteric, suprasphincteric, or extrasphincteric fistulas, which are located in deeper tissues and necessitate more extensive surgical dissection. In cases where an anal seton is employed, a non-absorbable suture is inserted into the fistula tract to facilitate drainage or promote fibrosis. This seton may be left loose or tightened gradually to create a cutting effect, allowing the fistula tract to heal over time. Additionally, a two-stage procedure may be indicated to minimize the risk of incontinence when the fistula traverses the anal sphincter, involving an initial opening or excision followed by a second surgical intervention to address the remaining fistula tract.