Summary & Overview
CPT 45119: Restorative Proctocolectomy with Colonic Pouch
CPT code 45119 describes a complex restorative proctocolectomy performed via combined abdominal and perineal approaches, with construction of a colonic reservoir and optional temporary diverting enterostomy. This procedure is clinically significant nationwide for treatment of conditions such as Crohn colitis, rectal cancer, and familial polyposis where preservation of an uninterrupted digestive tract is desired. It represents a high-acuity surgical service with substantial inpatient resource use and distinct coding and coverage considerations.
Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and service context, typical site-of-service expectations, and the coding definition. The publication also summarizes common modifiers and payer considerations where available, benchmark framing for inpatient surgical procedures, and policy or coverage update highlights relevant to this procedure.
This summary is intended to orient clinicians, billing professionals, and policy analysts to the clinical and administrative significance of CPT code 45119, and to outline the topics covered in the full publication, including benchmarks, payer policy implications, and clinical context for use of the code. Data not available in the input will be noted where applicable in the detailed sections.
Billing Code Overview
CPT code 45119 describes a surgical procedure in which the provider removes the rectum and connects the colon to the anus using both an abdominal and perineal approach. The procedure includes creation of a colonic reservoir (pouch) to collect fecal waste and may include a temporary diverting enterostomy when needed to allow the colon and anastomosis time to heal. The intent of the operation is to preserve an uninterrupted digestive tract so the patient can pass stool normally.
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Service type: Major abdominal and perineal colorectal resection with pouch construction
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Typical site of service: Inpatient hospital operating room with postoperative inpatient recovery
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no specific modifier applies and procedure is reported normally |