CPT 45123 Perineal Rectal Resection Reimbursement | OpenPayer

Summary & Overview

CPT 45123: Perineal Resection of Diseased Rectum, No Anastomosis

CPT code 45123 represents a perineal resection of a diseased rectal segment performed without reconnecting the remaining colon to the anus, typically done for colorectal cancer. This major operative code identifies a definitive oncologic resection using a perineal approach and is relevant to surgical oncology, colorectal surgery, and hospital inpatient billing workflows nationwide.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses coverage and reimbursement context for major commercial insurers and the federal payer, highlighting how this code interacts with surgical service lines, inpatient resource use, and cancer care pathways.

Readers will find a concise clinical framing of the procedure, expected sites of service, common billing modifiers and administrative considerations, and pointers to related coding areas where applicable. The summary provides benchmarks and policy-oriented commentary relevant to coding accuracy, claims processing, and payer coverage patterns that affect hospitals and surgical practices. Data not available in the input is clearly noted where detailed payer-specific rates, associated taxonomies, or ICD-10 diagnoses would otherwise appear.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 45123rectal resectionperineal approachcolorectal surgerysurgical oncologyinpatient surgeryoperative codecancer surgeryno anastomosis

Billing Code Overview

CPT code 45123 describes a surgical procedure in which a surgeon removes a portion of a diseased rectum via a perineal approach and does not reattach the remaining colon to the anus. This operation is performed for cancer of the colon or rectum.

Service type: Surgical resection of rectum (perineal approach) without colorectal anastomosis
Typical site of service: Inpatient hospital or surgical center (operating room)

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient presents with biopsy-proven distal rectal adenocarcinoma with symptomatic local disease and no feasible sphincter-preserving option. After staging with colonoscopy, pelvic MRI, and CT chest/abdomen/pelvis, the colorectal surgery team elects a perineal resection of the diseased rectum without immediate restoration of intestinal continuity (abdominoperineal resection variant via perineal approach). The typical workflow includes preoperative evaluation and optimization (anesthesia assessment, bowel preparation as indicated, informed consent discussing permanent colostomy), perioperative antibiotics and VTE prophylaxis, the operative procedure performed in the operating room under general anesthesia via a perineal incision to resect the distal rectum and associated mesorectum, specimen sent to pathology for margin and nodal assessment, and postoperative recovery in a post-anesthesia care unit with admission to a surgical floor for monitoring, pain control, ostomy care teaching, and discharge planning for home health or skilled nursing as needed. Typical site of service is an inpatient hospital operating room with postoperative inpatient stay. Service type is major surgical oncology/resection of rectum via perineal approach for cancer management.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds usual for this procedure (document specifics).

CPT 45135: Excision of Rectal Procidentia with Abdominal and Perineal Anastomosis

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

CPT 45111: Partial Rectal Resection, Abdominal Approach

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

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

CPT-45116-POSTERIOR-APPROACH-RECTAL-RESECTION-ANASTOMOSIS

CPT 45116: Posterior Rectal Resection with Colorectal Anastomosis

CPT-45119-RESTORATIVE-PROCTOCOLECTOMY-WITH-COLONIC-POUCH

CPT 45119: Restorative Proctocolectomy with Colonic Pouch

CPT-45110-ABDOMINOPERINEAL-RESECTION-WITH-COLOSTOMY

CPT 45110: Abdominoperineal Resection with Colostomy

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

CPT 45171: Transanal Local Excision of Rectal Tumor

CPT-45172-TRANSANAL-EXCISION-RECTAL-TUMOR-MUSCULARIS-PROPRIA

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

CPT-45108-ANORECTAL-TUMOR-EXCISION

CPT 45108: Excision of Anorectal Muscle Tumor

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

CPT 45112: Rectal Resection with Colonic Anastomosis to Anus

Showing 1–10 of 19

Taxonomy Code	Specialty	Notes
207RH0000X	Colon & Rectal Surgery	Primary specialty performing complex rectal resections.
207L00000X	General Surgery	Many colonic and rectal cancer resections are performed by general surgeons with colorectal expertise.
2084P0800X	Surgical Oncology	Involvement for cancer-directed resections and multidisciplinary cancer care.
208600000X	Anesthesiology	Provides perioperative anesthesia care for the procedure.
363A00000X	Ostomy Care/Cardiac/Vascular? (Data not provided)	Data not available in the input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C20`	Malignant neoplasm of rectum	Primary indication for rectal resection via perineal approach for oncologic control.
`C19`	Malignant neoplasm of rectosigmoid junction	Tumors at the rectosigmoid junction may require low rectal resection approaches; surgical planning similar.
`C18.9`	Malignant neoplasm of colon, unspecified	Colon cancer requiring resection when tumor extends into distal rectum or for synchronous lesions.
`K62.5`	Hemorrhage of anus and rectum	Symptomatic bleeding from rectal malignancy sometimes prompts urgent resection.
`K62.4`	Ulcer of anus and rectum	Local ulceration from malignancy or radiation injury may be present and addressed during resection.
`Z85.038`	Personal history of malignant neoplasm of large intestine	Relevant for staging, surveillance, and surgical decision-making in recurrent disease.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44140`	Colectomy, partial; without proctectomy, with anastomosis	Performed when resection includes a segment of colon with primary anastomosis rather than a perineal resection without reconstruction.
`45112`	Transanal proctosigmoidectomy, low anterior resection	Related low rectal resection codes for sphincter-preserving approaches; alternative surgical options.
`44120`	Colectomy, partial; with anastomosis, for benign or malignant disease	May be used when a partial colectomy with anastomosis is performed in the same hospitalization as part of oncologic management.
`43760`	Colostomy or ileostomy, creation, abdominal stoma	Creation of a permanent end colostomy often accompanies perineal rectal resection without anastomosis.
`88309`	Surgical pathology, gross and microscopic examination	Pathology processing and interpretation of the resected specimen for margins and staging.

OpenPayer