General Surgery Coding Alert

Question: The op report describes the surgeon identifying an internal anal fistula opening, then cutting open the fistula tract from the anal sphincter to the external anus, cutting open the fistula, and scraping/flushing the tract before stitching sides to open the fistula. How should we code this?

Tennessee Subscriber

Answer: The code that most accurately represents the procedure you’ve described is 46280 (Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed). The surgeon described a fistula that extends from the sphincter muscle to the external anal canal, so this is the most specific code.

Don’t confuse this code with 46270 (Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous), which describes a simpler procedure for a fistula located external to the sphincter muscle.

Similarly, you should not use 46275 (Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric) for the procedure you describe. Reserve that code for a fistula that does not extend beyond the anal sphincter.

Notice: Any of these three codes describe an anal fistula procedure that might entail a fistulotomy, as you described, or a fistulectomy.

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