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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the RectumCPT cpt-45113-proctectomy-ileoanal-anastomosis-ileal-pouch
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    CPT 45113: Partial Proctectomy with Ileoanal Anastomosis and Ileal Pouch

    Medicare pays $1724 on average nationally for this procedure.

    CPT code 45113 describes a partial proctectomy with resection of rectal mucosa and creation of an ileoanal anastomosis with an ileal reservoir (pouch), optionally including a loop ileostomy; this is a major colorectal surgical procedure performed for conditions such as Crohn colitis or rectal cancer. Service type: major colorectal surgery. Typical site of service: inpatient hospital operating room with possible temporary external ostomy care during recovery.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 48-year-old patient with refractory ulcerative colitis and dysplastic changes in the rectum is scheduled for a restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). The surgical team plans a total proctocolectomy with mucosal proctectomy of the residual rectal cuff, construction of a J-pouch from the terminal ileum, and ileoanal anastomosis. A loop ileostomy may be created intraoperatively for temporary fecal diversion. Preoperative workflow includes colorectal surgical consultation, colonoscopic evaluation with biopsy confirming dysplasia, bowel preparation, anesthesia pre-op assessment, and informed consent highlighting potential for stoma creation. Typical intraoperative steps include induction of general anesthesia, midline or lower abdominal incision (or laparoscopic ports), mobilization and resection of the colon and rectum with mucosectomy of the remaining rectal cuff, construction of an ileal reservoir (pouch), handsewn or stapled ileoanal anastomosis, and possible formation of a loop ileostomy. Postoperative workflow includes recovery in PACU, inpatient monitoring for anastomotic integrity, pain control, early mobilization, stoma care teaching if applicable, and outpatient follow-up for pouch function and ileostomy takedown planning if a diverting stoma was created.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44140Colectomy, partial; with anastomosisMay be used when segmental colectomy with anastomosis is performed in place of or prior to total proctocolectomy in staged management
    44160Colectomy, total, abdominal, with ileorectal anastomosisAlternative restorative approach when rectum is preserved and ileorectal anastomosis is performed instead of IPAA
    44207Laparoscopy, surgical; colectomy, partial, with anastomosisLaparoscopic approach codes when the colectomy and pouch formation are performed minimally invasively
    44625Proctectomy, partial with anastomosis; low anterior resectionMay be reported when low rectal resection with colo/ileoanal anastomosis is performed as part of oncologic management
    44120Enterectomy, resection of small intestine; single resection and anastomosisMay be used for limited small-bowel resections required during pouch construction or adhesiolysis

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208U00000X
    207L00000X
    207K00000X
    363L00000X
    333600000X
    261QP2000X
    146M00000X
    156FX1800X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    C19Malignant neoplasm of rectosigmoid junction
    C20Malignant neoplasm of rectum
    E86.0Dehydration
    E87.6Hypokalemia
    I82.90Acute embolism and thrombosis of unspecified vein
    K50.00Crohn's disease of small intestine without complications
    K50.10Crohn's disease of large intestine without complications
    K50.111Crohn's disease of large intestine with rectal bleeding
    K50.112Crohn's disease of large intestine with intestinal obstruction
    K50.919Crohn's disease, unspecified, with unspecified complications

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

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

    CPT 45100: Anal Approach Anorectal Wall Biopsy

    CPT-45108-ANORECTAL-TUMOR-EXCISION

    CPT 45108: Excision of Tumor of Anorectal Muscle

    CPT-45110-ABDOMINOPERINEAL-RESECTION-WITH-COLOSTOMY

    CPT 45110: Abdominoperineal Resection with Colostomy

    CPT-45111-PARTIAL-RECTAL-RESECTION-ABDOMINAL-APPROACH

    CPT 45111: Partial Resection of Rectum, Abdominal Approach

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

    CPT 45112: Abdominoperineal Resection of Rectum

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

    CPT 45114: Abdominoperineal Resection with Colorectal Anastomosis

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

    CPT 45116: Posterior Low Rectal Resection with Colon-Rectum Anastomosis

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

    CPT 45119: Abdominoperineal Proctocolectomy with Colonic Pouch

    CPT-45120-ABDOMINOPERINEAL-RECTAL-RESECTION-COLON-ANASTOMOSIS

    CPT 45120: Abdominoperineal Resection of Rectum

    CPT-45121-PULL-THROUGH-RESECTION-ABDOMINAL-PERINEAL-COLORECTAL-ANASTOMOSIS

    CPT 45121: Abdominoperineal Resection with Colon-to-Anus Anastomosis

    Showing 1–10 of 19

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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