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The procedure described by CPT® Code 46707 involves the repair of an anorectal fistula using a plug, specifically a porcine small intestine submucosa (SIS). An anorectal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, which can lead to discomfort and recurrent infections. The use of a plug for repair is considered a minimally invasive technique, which typically results in fewer complications compared to traditional surgical methods. During the procedure, the surgeon identifies both the internal and external openings of the fistula tract. The fistula is then curetted, which means that the tissue within the tract is scraped out to promote healing, and it is irrigated with an antibiotic solution to reduce the risk of infection. If a porcine SIS plug is utilized, it is prepared by rolling a 4-ply sheet of SIS tightly and securing the edge with sutures. The ends of the plug are then attached to suture ligatures, which are used to pull and position the plug within the fistula tract. After positioning, the plug is trimmed to be flush with the internal opening of the fistula, which is subsequently closed with sutures. In some cases, a sliding mucosal flap may be employed as an alternative method to close the internal opening. The expected healing time for the fistula is approximately five weeks, during which the plug facilitates the closure of the abnormal connection.
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The procedure for the repair of an anorectal fistula with a plug is indicated for patients presenting with the following conditions:
The procedure for repairing an anorectal fistula with a plug involves several key steps that ensure effective closure of the fistula tract:
After the procedure, patients can expect a recovery period during which the fistula is anticipated to close within approximately five weeks. Post-procedure care may include monitoring for signs of infection, managing pain, and following any specific instructions provided by the healthcare provider. Patients are typically advised to maintain proper hygiene and may be instructed to avoid certain activities that could strain the surgical site during the healing process. Regular follow-up appointments may be scheduled to assess the healing progress and address any concerns that may arise.
| Short Descr | REPAIR ANORECTAL FIST W/PLUG | Medium Descr | REPAIR ANORECTAL FISTULA PLUG | Long Descr | Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS]) | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | 0 - 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2011-01-01 | Changed | Medium description changed. |
| 2010-01-01 | Added | - |
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