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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the RectumCPT cpt-45119-restorative-proctocolectomy-with-colonic-pouch
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    CPT 45119: Abdominoperineal Proctocolectomy with Colonic Pouch

    Medicare pays $1736 on average nationally for this procedure.

    CPT code 45119 describes an abdominoperineal proctocolectomy with creation of a colonic reservoir (pouch) and possible temporary diverting enterostomy; this surgical service involves removal of the rectum with abdominal and perineal approaches and reconstruction to restore an uninterrupted digestive tract. Service type: major colorectal surgery with reservoir construction. Typical site of service: inpatient hospital operating room with perioperative inpatient recovery and possible temporary stoma care.

    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 rectal adenocarcinoma involving the mid and distal rectum is evaluated by colorectal surgery following staging and neoadjuvant chemoradiation. The surgical team plans an abdominoperineal approach to remove the rectum and create a colonic reservoir (pouch) with a colorectal/anal anastomosis and a temporary diverting loop ileostomy to protect the anastomosis during healing. The patient is taken to the operating room, receives general endotracheal anesthesia, and undergoes combined abdominal and perineal dissection: mobilization of the left colon, creation of a colonic J-pouch, low pelvic anastomosis to the anal canal, and formation of a temporary diverting enterostomy. Intraoperative steps include vascular control of the inferior mesenteric vessels as indicated, pelvic dissection with preservation of pelvic autonomic nerves when oncologically appropriate, pouch construction, leak testing of the anastomosis, and stoma maturation. Postoperative workflow includes recovery in PACU, inpatient surgical ward care with stoma education, postoperative imaging as indicated, and planned outpatient stoma reversal if and when the anastomosis has healed and oncologic therapy permits.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44140Colectomy, partial; with anastomosisPerformed when a segmental colectomy is required in conjunction with rectal resection or pouch construction
    44143Colectomy, partial; with anastomosis, with coloproctostomy (low pelvic anastomosis)May be used for portions of abdominal mobilization and anastomosis in multistep colorectal resections
    44625Excision or destruction of tumor(s) of rectum; transanalEndoluminal or transanal approaches may be used for distal tumor management in combined procedures
    44120Enterectomy, resection of small intestine, with anastomosisUsed if small-bowel resection is required for stoma creation or other intraabdominal indications
    44180Colectomy, total; with ileostomy or ileoproctostomy (loop or end)Related when a diversion requires ileostomy creation or when total colectomy is performed in the same episode

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207V00000X
    207L00000X
    207P00000X
    207K00000X
    208100000X
    261QX0100X
    101YM0800X
    2084A2900X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    C20Malignant neoplasm of rectum
    C21.0Malignant neoplasm of anus, unspecified
    C21.8Malignant neoplasm of overlapping sites of rectum, anus and anal canal
    D12.6Benign neoplasm of colon, unspecified
    D12.7Benign neoplasm of rectosigmoid junction
    K50.012Crohn's disease of small intestine with intestinal obstruction
    K50.013Crohn's disease of small intestine with fistula
    K51.412Inflammatory polyps of colon with intestinal obstruction
    K51.413Inflammatory polyps of colon with fistula
    K57.32Diverticulitis of large intestine without perforation or abscess without bleeding

    Showing 1–10 of 26

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

    CPT 45113: Partial Proctectomy with Ileoanal Anastomosis and Ileal Pouch

    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-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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