CPT® Code 46285

The CPT® Code 46285 refers to the surgical treatment of an anal fistula, specifically during the second stage of the procedure, which can involve either a fistulectomy or a fistulotomy. An anal fistula is defined as an abnormal connection between two epithelial surfaces, typically occurring in the anal region. The procedure begins with the identification of the fistula tract, which may involve the use of a probe or suture to locate the internal opening of the fistula from the external opening. Once the tract is identified, the surgical approach can either involve incising and opening the fistula tract (fistulotomy) to promote healing from the inside out or excising the entire fistula tract (fistulectomy). It is important to note that different codes are used for various types of anal fistulas based on their anatomical location and complexity. For instance, CPT® Code 46270 is designated for subcutaneous anal fistulas, while CPT® Code 46275 is used for intersphincteric fistulas. More complex fistulas, such as transsphincteric, suprasphincteric, or extrasphincteric fistulas, which require more extensive dissection, are coded with CPT® Code 46280. In cases where an anal 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 second stage of the procedure, represented by CPT® Code 46285, is performed to further address the fistula after an initial healing period, thereby reducing the risk of incontinence, especially when the fistula tract traverses the anal sphincter. This two-stage approach allows for a more controlled and safer surgical intervention.