Summary & Overview

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

CPT code 45114 covers a colorectal surgical resection in which part of the rectum is removed and the remaining rectum is joined to the colon using a combined abdominal and posterior sacral approach. This procedure is used to treat serious colorectal conditions such as Crohn colitis and rectal cancer and carries implications for surgical quality, perioperative resource use, and episode-of-care management nationwide. Key national payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and which payers are relevant to coverage and claims processing. The publication summarizes benchmarks for utilization, common billing considerations, and relevant policy updates that affect prior authorization, inpatient versus outpatient status, and global surgical packages. It also provides connections to clinical indications and postoperative care pathways to help billing and revenue teams align coding with clinical documentation. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45114CPTcolorectal surgeryrectal resectionanastomosissurgical codinghospital inpatientoperating roomperioperative care

Billing Code Overview

CPT code 45114 describes a surgical procedure in which the surgeon removes part of the rectum and creates an anastomosis, joining the remaining rectum to the colon. The operation is performed via a dual approach: an abdominal incision combined with access through the posterior sacral area. This procedure is indicated for conditions such as Crohn colitis or rectal cancer.

Service type: Surgical resection with colorectal anastomosis via combined abdominal and sacral (posterior) approach
Typical site of service: Inpatient or outpatient hospital surgical setting, operating room with potential inpatient stay depending on clinical indications and postoperative care needs

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old male with a mid-rectal adenocarcinoma causing intermittent bleeding and partial obstruction. After staging with colonoscopy, pelvic MRI, and CT chest/abdomen/pelvis, the multidisciplinary team recommends a combined abdominoperineal approach with low anterior resection and colorectal anastomosis via a dual abdominal and perineal (transsacral/perineal) approach to achieve oncologic margins and preserve sphincter function. Preoperative workflow includes bowel preparation, mechanical and antibiotic prophylaxis, venous thromboembolism prophylaxis, and informed consent addressing risks of anastomotic leak, infection, and need for diversion.

Intraoperative workflow: the patient is placed supine for the abdominal phase. The surgeon mobilizes the sigmoid and descending colon, divides vascular pedicles, and performs mesorectal excision. The team then transitions to the perineal/sacral approach to complete distal rectal dissection and obtain adequate distal margin. The colon is brought down and a colorectal or coloanal anastomosis is fashioned. Intraoperative decision-making may include temporary diverting ileostomy for high-risk anastomosis. Postoperative care focuses on analgesia, early ambulation, drain and ostomy management if present, and surveillance for anastomotic complications.

Typical site of service: inpatient hospital operating room for major colorectal surgery. Service type: major surgical procedure (open or combined open/transperineal) for colorectal resection and anastomosis.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for `45114` and documentation supports increased work.
`52`	Reduced services	Use when a component of the procedure was not performed or only partially performed.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons with distinct skills perform separate portions of the procedure concurrently or sequentially.
`66`	Surgical team	Use when a surgical team performs the procedure with documented roles and shared responsibility.
`80`	Assistant surgeon	Use when a surgical assistant (other than resident) assists and an assistant fee is billed.
`81`	Minimum assistant surgeon	Use when minimal assistant participation is documented.
`82`	Assistant surgeon (when qualified resident unavailable)	Use when a qualified resident is not available and assistant is required.
`56`	Preoperative management only	Use when only preoperative portion is performed by a provider who then does not participate in the surgery.
`54`	Surgical care only	Use when another clinician provides postoperative care and the primary surgeon bills only the operative service.
`57`	Decision for surgery (note: not in the provided list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
208000000X	Colon & Rectal Surgery	Primary specialty performing `45114` in cancer and inflammatory bowel disease.
208600000X	General Surgery	Frequently performs low anterior resections and colorectal anastomoses.
207T00000X	Surgery – Thoracic & Cardiovascular (not typical)	Data not available in the input.
208100000X	Gastroenterology	Typically involved in preoperative diagnosis and endoscopic staging; not primary operative specialty.
2080A0402X	Surgical Oncology	Performs complex oncologic colorectal resections in multidisciplinary centers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C20`	Malignant neoplasm of rectum	Primary oncologic indication for `45114` to achieve resection and anastomosis.
`K51.90`	Ulcerative colitis, unspecified, without complications	Inflammatory colitis that may require proctectomy and restorative anastomosis in severe disease.
`K50.012`	Crohn's disease of small intestine with rectal involvement	Crohn colitis with rectal disease that can necessitate segmental rectal resection.
`K62.5`	Hemorrhage of anus and rectum	Symptom that may be present with rectal neoplasm prompting surgical intervention.
`K59.1`	Functional diarrhea	Symptom management sometimes evaluated in the perioperative period; less commonly a primary indication.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45378`	Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Preoperative diagnostic staging and surveillance prior to `45114`.
`44140`	Colectomy, partial; with anastomosis	Alternative or adjacent partial colectomy procedures that may be performed if the tumor requires more proximal resection.
`44143`	Colectomy, partial; with colectomy, with coloproctostomy (low pelvic anastomosis)	Similar pelvic anastomotic procedures; may be billed for different extents of resection.
`44160`	Colectomy, total, abdominal, with ileorectal anastomosis	Performed when more extensive colonic resection is required, as part of broader surgical management.
`44204`	Laparoscopy, surgical; colectomy, partial, with colostomy or ileostomy	Laparoscopic approach or diversion creation that may accompany or precede `45114`.