# Surgical treatment of anal fistula 46280 & 46285



## tfischer (Jun 14, 2012)

The physician is doing surgical treatment of an anal fistula with seton placement, second stage. Is everything in CPT 46280 included in the 46285? Or do I need to be billing both 46280 and 46285?

Thank you!


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## physcoder (Jun 14, 2012)

A seton is a marker suture that is carried through the fistula and left for a period of time to encouage fibrotic tissues to form.  The seton also serves as a landmark for a second stage of fistula surgery when the tract is incised open.  
So i think that the seton should have been done previously for a second stage surgery to Be performed.  I KNOW THAT DOESN'T ANSWER YOUR QUESTION AND I DON'T KNOW THE ANSWER BUT THIS IS WHAT I FOUND IN GENERAL SURGERY COMPANION.  SO I TOO WILL BE WAITING ON THE ANSWER.
SORRY FOR THE CAPS


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## Lujanwj (Jun 14, 2012)

NCCI edit will direct you to use Modifier -59 in order to bill both codes which would mean you would have to show two separate and distinct lesions/fistula's are being treated when coding for both.  The key to your statement is Second Stage which mean you'll use 46285 only. With that said, anything the Dr does to treat the Fistula in the second stage is inherent to the code.


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