CPT 45110 Abdominoperineal Resection Reimbursement | OpenPayer

Summary & Overview

CPT 45110: Abdominoperineal Resection with Colostomy

CPT code 45110 represents an abdominoperineal resection with colostomy, a major surgical procedure that removes the rectum, part of the lower colon, and the anal sphincter, and creates a permanent colostomy. This operation is most often used for distal rectal cancers or severe Crohn colitis when the diseased segment cannot be managed via a transanal approach. Nationally, this code captures high-acuity colorectal surgical care with implications for hospital resource use, perioperative quality measures, and long-term patient management.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the procedure, the typical inpatient surgical setting where the service is delivered, and the common payer coverage landscape. The publication outlines benchmarking considerations, coding and billing context, and policy-relevant items such as documentation elements that support medical necessity for a major abdominoperineal resection. It also summarizes typical service lines and what to expect for coding workflows and recordkeeping. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 45110abdominoperineal resectioncolostomycolorectal surgeryinpatient surgerysurgical oncologyCrohn colitismedical billingprocedure coding

Billing Code Overview

CPT code 45110 describes an abdominoperineal resection in which the provider removes the entire rectum along with a portion of the lower colon and the anal sphincter, and creates a colostomy to divert the intestine through the abdomen. This operation is performed when the diseased rectum cannot be reached via an anal approach and is used to treat conditions such as Crohn colitis or cancer of the colon and rectum.

Service type: Major surgical resection of the rectum with permanent colostomy
Typical site of service: Inpatient hospital surgical setting

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old male with rectal adenocarcinoma extending to the distal rectum with involvement of the anal sphincter and low pelvic disease not amenable to sphincter-sparing resection. He presents after staging with pelvic MRI and colonoscopy confirming a low rectal tumor. Neoadjuvant chemoradiation may have been given followed by surgical planning. The operative workflow includes an abdominoperineal resection via combined abdominal and perineal approaches: abdominal mobilization of the sigmoid colon and rectum, high ligation of the inferior mesenteric vessels, mobilization of the left colon to achieve a tension-free colostomy, perineal dissection with complete removal of the anal sphincter complex and diseased rectum, and creation of an end colostomy on the left lower quadrant. Inpatient perioperative care includes preoperative optimization, general anesthesia, perioperative antibiotics, venous thromboembolism prophylaxis, intraoperative fluid and blood management, postoperative pain control, wound and perineal care, stoma education with ostomy nursing, and follow-up for adjuvant therapy if indicated.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (standard)	Use for routine reporting when no special circumstances apply
`11`

CPT 45111: Partial Rectal Resection, Abdominal Approach

CPT-45119-RESTORATIVE-PROCTOCOLECTOMY-WITH-COLONIC-POUCH

CPT 45119: Restorative Proctocolectomy with Colonic Pouch

CPT-45116-POSTERIOR-APPROACH-RECTAL-RESECTION-ANASTOMOSIS

CPT 45116: Posterior Rectal Resection with Colorectal Anastomosis

CPT-45126-PELVIC-EXENTERATION-FOR-ADVANCED-COLORECTAL-GENITOURINARY-CANCER

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

CPT-45160-TRANSSACRAL-TRANSCOCCYGEAL-EXCISION-RECTAL-TUMOR

CPT 45160: Excision of Rectal Tumor via Transsacral or Transcoccygeal Approach

CPT-45112-RECTAL-RESECTION-COLON-TO-ANUS-ANASTOMOSIS

CPT 45112: Rectal Resection with Colonic Anastomosis to Anus

CPT-45114-RECTAL-RESECTION-ANASTOMOSIS-ABDOMINAL-SACRAL-APPROACH

CPT 45114: Rectal Resection and Colon-Rectal Anastomosis, Abdominal and Sacral Approach

CPT-45130-PERINEAL-RECTAL-PROLAPSE-EXCISION-REANASTOMOSIS

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

CPT-45136-ILEOANAL-RESERVOIR-REMOVAL-ILEOSTOMY-CREATION

CPT 45136: Removal of Ileoanal Reservoir and Creation of Ileostomy

CPT-45108-ANORECTAL-TUMOR-EXCISION

CPT 45108: Excision of Anorectal Muscle Tumor

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Taxonomy Code	Specialty	Notes
`408600000X`	Colon and Rectal Surgery	Primary specialty for abdominoperineal resection; performs complex colorectal oncologic resections
`207L00000X`	General Surgery	Common specialty that performs colorectal resections when colorectal surgeons not available
`207P00000X`	Surgical Oncology	Specialty for oncologic resections within multidisciplinary cancer care
`363L00000X`	Ostomy Care	Support specialty (Wound, Ostomy and Continence Nurse) involved in perioperative stoma education and management

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K51.90`	Ulcerative colitis, unspecified, without complications	Inflammatory colitis potentially requiring proctocolectomy or abdominoperineal resection for refractory disease
`K50.919`	Crohn's disease of unspecified site, unspecified, without complications	Crohn colitis with severe distal involvement may require abdominoperineal resection when sphincter cannot be preserved
`C20`	Malignant neoplasm of rectum	Primary indication for abdominoperineal resection when tumor involves distal rectum and anal sphincter
`C19`	Malignant neoplasm of rectosigmoid junction	Tumors low in the rectum or rectosigmoid junction may necessitate extensive resection including colostomy
`K62.5`	Hemorrhage of anus and rectum	Severe uncontrollable bleeding from distal rectum may rarely lead to resection when other measures fail

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45380`	Colonoscopy, flexible; with biopsy, single or multiple	Preoperative diagnostic procedure to biopsy rectal or colonic lesions prior to planning `45110`
`44140`	Colectomy, partial; with anastomosis	Alternative or preceding procedure when segmental resection with primary anastomosis is feasible instead of abdominoperineal resection
`44625`	Excision of rectal tumor via transanal approach	Performed for select distal lesions amenable to transanal resection; not appropriate when disease cannot be reached via anal approach as in `45110`
`44204`	Laparoscopy, surgical; colectomy, partial, with anastomosis	Minimally invasive approach for colectomy when sphincter-sparing resection is possible; may be attempted before conversion to open `45110` when disease extent mandates abdominoperineal resection
`43845`	Colostomy or enterostomy, creation, end colostomy	Code describing creation of an end colostomy; often reported in conjunction with or as component of the operation described by `45110` depending on billing conventions

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