CPT 45111 Partial Rectal Resection Reimbursement | OpenPayer

Summary & Overview

CPT 45111: Partial Rectal Resection, Abdominal Approach

CPT code 45111 denotes a partial resection of the rectum performed through an abdominal approach when the diseased segment cannot be safely reached transanally or via the perineum. The code captures a major colorectal surgical procedure commonly employed for Crohn colitis and rectal cancer and is relevant to surgical billing, inpatient quality reporting, and national expenditure for colorectal disease care. Nationally, this procedure is a component of complex colorectal surgery pathways that influence hospital resource use, length of stay, and post-operative care patterns.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context and service setting, typical payer coverage considerations, and commonly reported modifiers. The publication also summarizes benchmark metrics and policy considerations affecting coverage and coding practice. Clinical context covers indications, approach rationale, and expected operative setting; billing context addresses payer mix, reimbursement drivers, and coding nuances relevant to surgical teams and billing departments.

Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, related codes, or granular payer-specific reimbursement rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 45111rectal resectioncolorectal surgeryabdominal approachsurgical billinginpatient surgeryrectal cancerCrohn colitisprocedure coding

Billing Code Overview

CPT code 45111 describes a partial resection of the rectum performed via an abdominal approach. The procedure is used when the diseased segment of the rectum cannot be accessed safely through an anal or transperineal route. Typical clinical indications include Crohn colitis and rectal cancer.

Service Type: Surgical — Partial rectal resection, abdominal approach

Typical Site of Service: Hospital operating room or inpatient surgical suite

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a mid-rectal adenocarcinoma presents with progressive rectal bleeding, tenesmus, and imaging showing a tumor located above the anal canal that cannot be safely accessed transanally. After multidisciplinary review, the colorectal surgeon schedules an elective partial resection of the rectum via an abdominal approach to remove the diseased segment and restore intestinal continuity. The clinical workflow includes preoperative staging (CT chest/abdomen/pelvis), bowel preparation, informed consent documenting indication and planned procedure, anesthesia evaluation, intraoperative abdominal approach with mobilization of the rectum, resection of the involved segment, and either primary anastomosis or creation of a temporary diverting ostomy as indicated. Postoperative care involves pain control, early ambulation, monitoring for anastomotic leak or bleeding, pathology review of the specimen to determine margins and staging, and coordination of adjuvant therapy if malignant disease is confirmed.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier applicable or not provided by payer	Rarely used; default when no other modifier applies and the payer requires a placeholder.
`11`

CPT 45135: Excision of Rectal Procidentia with Abdominal and Perineal Anastomosis

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

CPT 45116: Posterior Rectal Resection with Colorectal Anastomosis

CPT-45108-ANORECTAL-TUMOR-EXCISION

CPT 45108: Excision of Anorectal Muscle Tumor

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

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

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

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

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

CPT 45136: Removal of Ileoanal Reservoir and Creation of Ileostomy

CPT-45171-TRANSANAL-LOCAL-EXCISION-RECTAL-TUMOR

CPT 45171: Transanal Local Excision of Rectal Tumor

CPT-45100-ANORECTAL-WALL-BIOPSY-ANAL-APPROACH

CPT 45100: Anal Approach Biopsy of Anorectal Wall

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

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

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

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

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Taxonomy Code	Specialty	Notes
`207R00000X`	Colon & Rectal Surgery	Primary specialty performing `45111` in most centers.
`208000000X`	General Surgery	General surgeons with colorectal expertise commonly perform abdominal rectal resections.
`207L00000X`	Surgical Oncology	Surgical oncologists perform resections for malignant rectal disease.
`207RC0000X`	Thoracic & Cardiac Surgery	Not typical; included only if thoracoabdominal access required (uncommon).
`363LP0800X`	Anesthesiology	Provides intraoperative anesthesia support and billing for anesthesia services.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C20`	Malignant neoplasm of rectum	Primary indication for partial resection of the rectum via abdominal approach to achieve oncologic resection.
`K50.814`	Crohn disease of large intestine with intestinal obstruction	Crohn colitis with obstructive features can necessitate abdominal rectal resection when transanal access is not feasible.
`K51.212`	Ulcerative colitis, left-sided, with rectal bleeding	Severe inflammatory colitis with complications may require partial proctectomy.
`K62.5`	Hemorrhage of anus and rectum	Significant bleeding from rectal lesions refractory to endoscopic therapy may require surgical resection.
`K57.50`	Diverticulosis of large intestine without perforation or abscess	Complicated diverticular disease involving the rectum/sigmoid may require resection via abdominal approach.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44140`	Colectomy, partial; with anastomosis	Used when tumor extends into the sigmoid or requires partial colectomy in addition to rectal resection.
`44143`	Colectomy, partial; with coloproctostomy (low pelvic anastomosis)	Performed when a low colorectal/coloproctostomy anastomosis is created after resection.
`44160`	Colectomy, partial; with removal of terminal ileum with ileocolostomy	May be performed if disease involves terminal ileum necessitating extended resection.
`44145`	Colectomy, partial; with colostomy or ileostomy	Used when a stoma is created instead of primary anastomosis.
`47562`	Laparoscopy, surgical; cholecystectomy (for concomitant procedures)	Example of a concurrent abdominal procedure sometimes staged or performed during same hospitalization; listed as commonly associated ancillary abdominal procedures.

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