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Official Description

Repair of anal fistula with fibrin glue

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 46706 involves the repair of an anal fistula using fibrin glue, a biocompatible adhesive that promotes healing. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection or abscess. The procedure begins with the preparation and draping of the perineum, ensuring a sterile environment. A digital rectal exam is performed to assess the condition and locate the fistula accurately. An anoscope, a tubular instrument, is then utilized to visualize the anal canal and identify the specific site of the fistula. Following this, a probe is introduced into the internal opening of the fistula, allowing the clinician to trace the fistulous tract to its external opening. To facilitate the repair, a curette is employed to remove any granulation tissue that may obstruct the healing process within the fistula tract. Finally, a flexible catheter is inserted at the internal opening, and fibrin glue is injected to fill the entire fistulous tract, effectively sealing it and promoting closure. This minimally invasive technique aims to reduce recovery time and complications associated with traditional surgical methods for fistula repair.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure for the repair of an anal fistula with fibrin glue is indicated for patients presenting with the following conditions:

  • Anal Fistula A pathological connection between the anal canal and the skin, often resulting from previous infections or abscesses.
  • Granulation Tissue Presence of granulation tissue within the fistula tract that may impede healing and requires removal.
  • Recurrent Fistulas Patients with recurrent anal fistulas who may benefit from a less invasive repair method.

2. Procedure

The procedure for repairing an anal fistula with fibrin glue involves several key steps that ensure effective treatment.

  • Preparation and Draping The perineum is meticulously prepared and draped to maintain a sterile field, which is crucial for preventing infection during the procedure.
  • Digital Rectal Exam A digital rectal exam is performed to assess the anatomy of the anal region and to locate the fistula accurately, providing essential information for the subsequent steps.
  • Anoscopy An anoscope is introduced to examine the anal canal closely, allowing the clinician to visualize the internal opening of the fistula and confirm its location.
  • Probe Introduction A probe is carefully inserted into the internal opening of the fistula and advanced through the tract to the external opening, which helps in mapping the fistulous pathway.
  • Granulation Tissue Removal A curette is utilized to remove any granulation tissue from the fistula tract, which is important for ensuring that the fibrin glue can adhere properly and promote healing.
  • Catheter Insertion A flexible catheter is then inserted at the internal opening of the fistula, allowing for the precise delivery of the fibrin glue into the fistulous tract.
  • Fibrin Glue Application Finally, the entire fistulous tract is filled with fibrin glue, which acts as a sealant to close the fistula and facilitate healing.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications. Post-procedure care may include instructions on maintaining hygiene in the anal area to prevent infection and promote healing. Patients may also be advised on pain management strategies, as some discomfort is expected following the procedure. Follow-up appointments are essential to assess the healing process and ensure that the fistula has closed properly. Any signs of infection or recurrence should be reported to the healthcare provider promptly.

Short Descr REPR OF ANAL FISTULA W/GLUE
Medium Descr REPAIR ANAL FISTULA W/FIBRIN GLUE
Long Descr Repair of anal fistula with fibrin glue
Status Code Active Code
Global Days 010 - Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P6C - Minor procedures - other (Medicare fee schedule)
MUE 1
CCS Clinical Classification 96 - Other OR lower GI therapeutic procedures
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
GC This service has been performed in part by a resident under the direction of a teaching physician
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2003-01-01 Added First appearance in code book in 2003.
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