CPT® Code 46280

Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed

The CPT® Code 46280 refers to the surgical treatment of anal fistulas, specifically through procedures known as fistulectomy or fistulotomy. An anal fistula is defined as an abnormal passage that connects one epithelial surface to another, typically resulting from an infection or abscess in the anal region. The procedure is indicated for various types of anal fistulas, including transsphincteric, suprasphincteric, extrasphincteric, or multiple fistulas. These classifications indicate the depth and complexity of the fistula, with transsphincteric, suprasphincteric, and extrasphincteric fistulas being located in deeper tissues, necessitating more extensive surgical dissection to accurately locate and treat the fistula tract. 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 may involve incising and opening the fistula tract (fistulotomy) to facilitate healing from the inside out, or excising the fistula tract entirely (fistulectomy). In cases where a seton is placed, a non-absorbable suture material is inserted into the external opening of the fistula tract, passed through the internal opening, and then pulled back out of the anal canal. This seton can be left loose for drainage and fibrosis or can be a cutting type seton, which gradually opens the fistulous tract over time. The procedure may also be performed in two stages to minimize the risk of incontinence, particularly when the fistula traverses the anal sphincter. In the first stage, part of the fistula is treated, allowing for healing before addressing the remainder in a subsequent surgical session.