CPT® Code 46730

An imperforate anus is a congenital condition characterized by the absence of a proper anal opening, which can manifest as either a complete lack of an anal orifice or the presence of a small, improperly positioned fistulous tract. The term "high imperforate anus" is considered outdated; however, it generally refers to a malformation that occurs above the levator ani muscles, which are critical components of the pelvic floor. In contemporary medical practice, anorectal malformations are classified based on their anatomical features rather than outdated terminology. The procedure described by CPT® Code 46730 involves a surgical repair of a high imperforate anus using either a perineal or sacroperineal approach. This technique includes the identification of the anorectal muscle complex through the use of a muscle-stimulating device, which aids in accurately locating the necessary anatomical structures. The surgical process entails making an incision in the perineum, either anterior or posterior to the anorectal muscles, and carefully dissecting to reach the presacral space. Once the rectal pouch is located, it is mobilized while ensuring complete separation from any attachments to the genitourinary tract. The procedure culminates in the creation of a functional anal opening by suturing the rectal mucosa to the skin, thereby establishing a new anal orifice.