Summary & Overview

CPT 45000: Transrectal Drainage of Pelvic Abscess

CPT code 45000 represents transrectal drainage of a pelvic abscess, a targeted procedural intervention to evacuate a walled-off pus collection in the pelvis. This procedure is clinically important because it relieves pain and reduces the risk of systemic spread of infection; it also has implications for hospital resource use, interventional radiology and surgical service lines, and post-procedure care pathways. Nationally, pelvic abscess drainage is performed in acute care settings and is relevant across public and commercial payers.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find an overview of typical sites of service and the clinical context for the procedure, followed by benchmarking and payer coverage considerations where available. The publication highlights common utilization themes, coding and billing practice points, and policy developments that affect procedural approvals and reimbursement processes. Where payer-specific details are not provided, the document indicates that data are not available in the input. The goal is to give clinicians, coding professionals and policy analysts a concise national-level briefing on CPT code 45000, its clinical role, and the areas that drive coverage and billing variability.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45000CPTpelvic abscesstransrectal drainageinterventional radiologysurgical procedureshospital servicesprocedure coding

Billing Code Overview

CPT code 45000 describes drainage of a pelvic abscess using a transrectal approach. The procedure involves accessing a walled-off collection of pus in the pelvis and evacuating it to treat pain and to prevent spread of infection.

Service Type: Percutaneous/transrectal pelvic abscess drainage procedure

Typical Site of Service: Hospital operating room, interventional radiology suite, or procedural unit with access to transrectal instrumentation

Clinical & Coding Specifications

Clinical Context

A 34-year-old woman presents to the emergency department with 5 days of worsening lower abdominal and pelvic pain, fever to 102°F, and purulent vaginal discharge. Pelvic examination and pelvic ultrasound/CT demonstrate a complex, loculated pelvic fluid collection posterior to the uterus consistent with a pelvic abscess. The patient has elevated white blood cell count and signs of systemic infection despite broad-spectrum IV antibiotics. Interventional radiology or a colorectal surgeon is consulted. After informed consent, the provider performs a transrectal drainage of the pelvic abscess under ultrasound or CT guidance to evacuate purulent material, obtain cultures, relieve pain, and control ongoing sepsis. The procedure is typically performed in an interventional radiology suite or operating room with conscious sedation or general anesthesia, with intraprocedural imaging guidance and sterile technique. Post-procedure, the patient is observed for hemodynamic stability, drainage output, and response to antibiotics; cultures guide targeted antimicrobial therapy. Typical sites of service include the interventional radiology suite, operating room, or ambulatory surgery center depending on clinical status and facility capabilities. Common payors for billing include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds usual for (document justification).

Taxonomy Code	Specialty	Notes
207RX0400X	General Surgery	General surgeons perform transrectal pelvic abscess drainage when colorectal involvement or operative intervention is required.
207RH0000X	Colorectal Surgery	Colorectal surgeons commonly perform transrectal drainage for deep pelvic abscesses adjacent to rectum.
2080P0003X	Interventional Radiology	Interventional radiologists perform image‑guided transrectal or transgluteal pelvic abscess drainage.
207V00000X	Obstetrics & Gynecology	OB/GYNs manage pelvic infections and may perform or coordinate drainage for gynecologic abscesses.
363L00000X	Infectious Disease	Infectious disease specialists provide antimicrobial management and interpret culture results post‑drainage.

CPT Code	Description	Relationship to This Procedure
`76942`	Ultrasonic guidance for needle placement (eg, imaging supervision and interpretation)	Frequently used to guide transrectal needle or catheter placement during drainage of a pelvic abscess.
`77012`	CT guidance for percutaneous drainage	Used when CT imaging is the modality for needle/catheter localization and drainage.
`50390`	Drainage of renal abscess, percutaneous	Analogous percutaneous drainage code; sometimes referenced for technique similarity but not used for pelvic abscess.
`49905`	Drainage of intra-abdominal abscess (shallower codes vary)	Other intra‑abdominal abscess drainage codes may be reported when pelvic approach or anatomy differs; verify payer coding rules.
`96374`	Therapeutic, prophylactic, or diagnostic injection (intralesional)	May be used if local instillation of medication (eg, antibiotics) into abscess cavity occurs as a separate reportable service.

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