CPT 45120 Abdominoperineal Resection Reimbursement | OpenPayer

Summary & Overview

CPT 45120: Abdominoperineal Rectal Resection with Colon-Anus Anastomosis

CPT code 45120 represents a major colorectal operation involving removal or bypass of diseased rectum with restoration of intestinal continuity by connecting the colon and anus via both abdominal and perineal approaches. This procedure is clinically significant for management of invasive rectal disease, trauma, or complex benign conditions that require combined access for resection and reconstruction. Nationally, it is a high-acuity inpatient surgical service with implications for operating-room resource use, perioperative care pathways, and postoperative bowel function outcomes.

Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing description of the procedure, typical site-of-service information, and the context needed for claims processing and coding accuracy. The publication outlines benchmarks and policy-relevant considerations such as inpatient surgical classification, resource intensity, and clinical indications that impact utilization and payment. It also highlights areas where payers commonly apply coverage criteria and prior authorization for complex colorectal surgeries.

This national overview is intended for coding professionals, clinicians involved in colorectal surgery, and payers seeking clarity on procedural definition and typical delivery setting. Data not available in the input: detailed payer-specific reimbursement rates, ICD-10 diagnosis pairings, and associated taxonomies.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicare45120CPTcolorectal-surgeryabdominoperineal-procedureinpatient-surgeryrectal-resectioncolon-anastomosis

Billing Code Overview

CPT code 45120 describes a surgical procedure in which the provider removes or bypasses a diseased portion of the rectum and connects the colon and anus using both an abdominal and perineal approach. This is a major colorectal operation addressing rectal disease that requires combined abdominal and perineal operative access.

Service type: Major colorectal surgery (combined abdominal and perineal resection/reconstruction)
Typical site of service: Hospital operating room, inpatient surgical setting

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a long history of rectal cancer who presents with a locally advanced, nonmetastatic tumor involving the distal rectum and perineal tissues. After multidisciplinary review and neoadjuvant chemoradiation, the surgical team schedules an abdominoperineal resection to remove the diseased rectum and create a permanent colostomy. The procedure uses both an abdominal and perineal approach: an exploratory laparotomy or minimally invasive abdominal mobilization of the colon, ligation of mesenteric vessels, resection of the rectum, and a perineal dissection with removal of the distal rectum and anal canal. Intraoperative steps include identification and protection of ureters, pelvic hemostasis, specimen extraction, and creation of an end colostomy.

Typical clinical workflow:

Preoperative evaluation with history, physical exam, colonoscopy, pelvic MRI, CT chest/abdomen/pelvis, and anesthesia assessment.
Preop optimization (bowel prep as indicated, VTE prophylaxis planning, perioperative antibiotics).
Operation in the operating room under general anesthesia with both abdominal and perineal teams as needed.
Postoperative inpatient care in a surgical ward or step-down unit with pain control, stoma education, wound care, and discharge planning.

Typical site of service: Hospital inpatient operating room and postoperative inpatient stay.

Service type: Major surgical procedure—abdominoperineal resection (open or combined approach) requiring surgical and perioperative inpatient resources.

Coding Specifications

CPT 45119: Restorative Proctocolectomy with Colonic Pouch

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

CPT 45121: Pull-Through Resection with Colorectal Anastomosis

CPT-45126-PELVIC-EXENTERATION-FOR-ADVANCED-COLORECTAL-GENITOURINARY-CANCER

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

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

CPT 45100: Anal Approach Biopsy of Anorectal Wall

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

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

CPT-45171-TRANSANAL-LOCAL-EXCISION-RECTAL-TUMOR

CPT 45171: Transanal Local Excision of Rectal Tumor

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

CPT 45112: Rectal Resection with Colonic Anastomosis to Anus

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

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

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

CPT 45113: Partial Proctectomy with Ileoanal Anastomosis and Ileal Pouch

CPT-45108-ANORECTAL-TUMOR-EXCISION

CPT 45108: Excision of Anorectal Muscle Tumor

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Taxonomy Code	Specialty	Notes
`208100000X`	General Surgery	Most common specialty performing abdominoperineal resections.
`207L00000X`	Colon & Rectal Surgery	Subspecialists who frequently perform complex rectal cancer resections.
`207R00000X`	Surgical Oncology	Surgeons focusing on oncologic resections of pelvic malignancies.
`207H00000X`	Thoracic & Cardiac Surgery	Not typical; omitted in practice but included for multidisciplinary cases.
`363L00000X`	Anesthesiology	Provides perioperative anesthesia services for major abdominal and perineal procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C20`	Malignant neoplasm of rectum	Primary indication for abdominoperineal resection when tumor involves distal rectum/anal canal.
`C21.8`	Malignant neoplasm of overlapping sites of anus and rectum	Relevant when tumor spans rectum and anal canal requiring extended resection.
`K62.5`	Rectal prolapse	Chronic full-thickness prolapse may rarely require perineal and abdominal approaches.
`K62.5`	Anal sphincter disruption (useful clinical correlate)	When sphincter destruction necessitates removal of distal rectum and permanent colostomy.
`K57.2`	Diverticulitis of large intestine with perforation and peritonitis	Complicated colorectal disease potentially requiring resection and perineal procedures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44140`	Colectomy, partial; with anastomosis	Performed if additional colonic resection with primary anastomosis is necessary during abdominal mobilization.
`44204`	Laparoscopy, surgical, colon resection; with colorectal anastomosis	Laparoscopic approach codes that may be used if portions of the operation are minimally invasive prior to perineal completion.
`45395`	Colonoscopy, flexible; with removal of tumor(s) by transanal surgical approach	May be used for diagnostic or therapeutic transanal tumor management in staged or combined procedures.
`44160`	Colectomy, total; when subtotal colectomy portions are required	Used if a more extensive colectomy is performed in conjunction with rectal resection.
`49560`	Repair of incisional or ventral hernia with or without mesh	May be reported if an abdominal wall repair is performed in the same operative session.

`11`	Principal physician of record	Use when the reporting surgeon is the primary surgeon responsible for the procedure.
`22`	Increased procedural services	Use when additional work beyond the usual is required (e.g., extensive adhesiolysis, unexpected complexity).
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and an unusual anesthesia circumstance is documented.
`50`	Bilateral procedure	Rare for this pelvic procedure; use only if an additional bilateral operation on paired organs is performed and reported appropriately.
`51`	Multiple procedures	Use when `45120` is reported with other distinct procedures during the same operative session.
`52`	Reduced services	Use when the procedure is attempted but substantially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances prior to completion.
`54`	Surgical care only	Use when another provider reports the postoperative care separately.
`55`	Postoperative management only	Use when reporting only the postoperative management portion by a surgeon other than the operating surgeon.
`62`	Two surgeons	Use when two surgeons of different specialties operate together and both perform distinct portions of the procedure.
`63`	Procedures in neonates/infants	Not typically applicable; include only if patient age criteria are met.
`78`	Return to OR for related procedure during postoperative period	Use for reoperation for complications related to the initial `45120`.
`79`	Unrelated procedure or service by the same physician during postoperative period	Use when a separate unrelated procedure is performed during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon provides substantial assistance during the operation.

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