CPT® Code 46740

An imperforate anus is a congenital condition characterized by the absence of a normal anal opening, which can manifest as a complete lack of an anal orifice or the presence of a small fistulous tract. The term "high imperforate anus" is considered outdated; however, it typically refers to a malformation located above the levator ani muscles, which are critical components of the pelvic floor. In contemporary medical practice, anorectal malformations are classified based on their anatomical features rather than outdated terminology.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 46740 involves a surgical repair of a high imperforate anus accompanied by either a rectourethral or rectovaginal fistula. This surgical intervention is performed through a perineal or sacroperineal approach, which allows the surgeon to access the affected area effectively. During the procedure, a muscle-stimulating device is utilized to identify the anorectal muscle complex, ensuring precise dissection and mobilization of the rectal pouch. The surgical steps include making incisions, dissecting to the presacral space, and carefully separating the rectum from any attachments to the genitourinary tract. The identification and excision of the fistulous tract are critical components of the repair, followed by the closure of the wound and the creation of a functional anal opening by suturing the rectal mucosa to the skin. This comprehensive approach aims to restore normal anatomy and function for the patient.