CPT 45116 Posterior Rectal Resection Reimbursement | OpenPayer

Summary & Overview

CPT 45116: Posterior Rectal Resection with Colorectal Anastomosis

CPT code 45116 denotes a posterior approach rectal resection with colorectal anastomosis, commonly used in the surgical management of rectal cancer. The code captures a complex pelvic operation that includes removal of the coccyx and part of the left sacral wing to access and excise disease, followed by rejoining the remaining rectum to the colon. Nationally, this code matters because it represents a high-complexity inpatient surgical service with implications for hospital coding, surgical quality measurement, and oncology care pathways.

Key payers reviewed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise clinical and coding orientation to the procedure, understand typical sites of service and service type, and see what elements are commonly relevant when this code is billed. The publication also outlines typical payer coverage context and operational considerations for hospitals and surgical teams.

The report provides benchmarks and policy context where available, highlights the clinical circumstances that drive use of this code, and notes when additional documentation is typically necessary to substantiate the complexity of the procedure. Data not available in the input will be identified explicitly in the detailed sections of the publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45116CPTrectal resectioncolorectal surgeryoncologic surgeryposterior approachinpatient surgery

Billing Code Overview

CPT code 45116 describes a surgical procedure in which part of the rectum is removed and the remaining rectum is anastomosed (joined) to the colon. The procedure is performed via a posterior approach that includes removal of the coccyx (tail bone) and part of the left sacral wing. This operation is typically performed to treat rectal cancer.

Service type: Surgical resection with colorectal anastomosis via posterior approach
Typical site of service: Inpatient hospital operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old with mid- to low-rectal adenocarcinoma who presents after staging that demonstrates a tumor involving the posterior distal rectum without distant metastasis. Preoperative workup includes colonoscopy with biopsy confirming malignancy, pelvic MRI for local staging, CT chest/abdomen/pelvis for metastasis evaluation, and optimization of comorbidities (cardiac, pulmonary, diabetes). Neoadjuvant chemoradiation may be completed prior to surgery depending on tumor stage. The patient is brought to the operating room for a posterior approach abdominoperineal resection with partial sacrectomy and coccygectomy and colorectal anastomosis. Intraoperative steps include prone positioning, posterior midline incision, resection of the coccyx and part of the left sacral wing, mobilization of the rectum, distal rectal resection, and anastomosis of the remaining rectum to the sigmoid colon. A diverting ileostomy may be created based on anastomotic risk. Postoperative care involves ICU or PACU monitoring, pain control, wound care for the perineal defect, early ambulation, DVT prophylaxis, and coordination of adjuvant therapy if indicated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or time is substantially greater than typical for this major resection (extensive adhesiolysis, unexpected complexity).

CPT 45172: Transanal Excision of Rectal Tumor, Full-Thickness

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

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

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

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

CPT-45113-PROCTECTOMY-ILEOANAL-ANASTOMOSIS-ILEAL-POUCH

CPT 45113: Partial Proctectomy with Ileoanal Anastomosis and Ileal Pouch

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

CPT 45111: Partial Rectal Resection, Abdominal Approach

CPT-45110-ABDOMINOPERINEAL-RESECTION-WITH-COLOSTOMY

CPT 45110: Abdominoperineal Resection with Colostomy

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

CPT 45136: Removal of Ileoanal Reservoir and Creation of Ileostomy

CPT-45123-PERINEAL-RECTAL-RESECTION-WITHOUT-ANASTOMOSIS

CPT 45123: Perineal Resection of Diseased Rectum, No Anastomosis

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

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Taxonomy Code	Specialty	Notes
207P00000X	Colorectal Surgery	Primary specialty performing low rectal resections and complex pelvic exenterative procedures.
207L00000X	General Surgery	General surgeons with expertise in colorectal resections often perform this procedure.
2080P0207X	Colon & Rectal Surgery	Alternate taxonomy for specialists focused on colon and rectal disease.
208000000X	Surgical Oncology	Surgical oncologists perform oncologic resections of the rectum, especially when multi-visceral resection is required.
261QP2400X	Orthopedic Spine Surgery	May participate when sacral bone resection/partial sacrectomy is extensive and requires spine expertise.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C20`	Malignant neoplasm of rectum	Primary indication for rectal resection with partial sacrectomy and anastomosis in locally advanced disease.
`C21.8`	Malignant neoplasm of overlapping sites of rectum, anus and anal canal	Relevant when tumor spans rectal and perianal regions requiring extended posterior approach.
`C19`	Malignant neoplasm of rectosigmoid junction	Tumors at the rectosigmoid junction may require low rectal resection and anastomosis.
`K62.5`	Ulceration of anus and rectum	Relevant for differential diagnosis and may complicate resection or healing if present.
`K91.82`	Complications of anastomosis, rectum	Postoperative diagnosis used if anastomotic leak or complication occurs after the procedure.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44140`	Colectomy, partial; with anastomosis	Performed when an extended colectomy is required proximal to the rectal resection or when mobilization of the colon is required to create a tension-free colorectal anastomosis.
`44625`	Proctectomy, complete; abdominal and perineal approach (Miles), with colostomy	Alternative approach when sphincter-sparing anastomosis is not possible; used in low rectal cancers requiring permanent colostomy.
`44204`	Laparoscopy, surgical, colectomy, partial; with anastomosis	Minimally invasive alternative or adjunct for mobilizing the colon prior to anastomosis in selected patients.
`44615`	Proctectomy, rectal resection, low anterior resection (LAR)	Closely related pelvic resection for rectal cancer when performed via abdominal approach; overlaps in clinical indications and technique.
`44188`	Colectomy, partial, with removal of terminal ileum with ileocolostomy	Used when more extensive resection including terminal ileum is necessary to achieve margins or for diversion creation.
`45397`	Colonoscopy with removal of tumor (endoscopic)	Preoperative or diagnostic endoscopic procedures for tumor debulking or localization prior to definitive resection.

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