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garivo06 Posted Wed 20th of December, 2017 17:26:51 PM
Hi may question is are these two procedure code 46270 and 46020 bundled -or this is better coded with cpt 46275 Thank you- The patient was placed on the operating table in the prone position Monitored anesthesia care was administered The surgical site was prepped and draped in the usual sterile fashion. A timeout was performed. Digital rectal exam was performed. No masses were noted. Twenty mL of 0.25% Marcaine with epinephrine were administere as a pudendal nerve block. A subcentimeter external fistula opening was noted posteriorly just right of midline, within a centimeter of the anal verge. A fistula probe was placed in the tract and the internal fistula opening was easily found near the dentate line. There was tan drainage expressed from the internal fistula opening. There appeared to be a small amount of sphincter muscle involved with the fistula. The external opening was extended approximately 1 em. The external fistula opening was debrided with a curette and hemostasis was assured. A silicone band was then passed through the fistula tract as a Seton. Twenty mL of Exparel was then administered as a pudendal nerve block and directly at the external fistula opening The surgical site was cleaned and a sterile dressing was placed.
SuperCoder Answered Thu 21st of December, 2017 03:25:12 AM


The appropriate CPT code for the above-mentioned procedure would be 46280. CPT code 46280 includes transsphincteric, suprasphincteric, extrasphincteric fistula repair with placement of seton. You need not to bill CPT code 46020 as a separate code for placement of seton. Since sphincter muscle is involved with the fistula, 46280 would be the preferred code over CPT codes 46270 and 46275.   


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