Summary & Overview
CPT 45135: Excision of Rectal Procidentia with Abdominal and Perineal Anastomosis
CPT code 45135 denotes a combined abdominal and perineal surgical excision of rectal procidentia with reconnection of the colon to the remaining rectum. This complex colorectal procedure addresses partial or complete rectal prolapse and typically requires coordinated abdominal and perineal access to ensure complete resection and secure anastomosis. Nationally, the code captures procedures that can impact surgical outcomes, postoperative resource use, and reimbursement patterns for colorectal surgery.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers what this code represents clinically, typical sites of service, and the broad categories of benchmarks and policy considerations payers use to evaluate utilization and coverage.
Readers will learn how CPT code 45135 is applied in clinical practice, the typical service context (operating room in hospital or ambulatory surgical center), and the elements often examined in payer policies such as inpatient versus outpatient status, medical necessity for combined approaches, and operative complexity. Data not available in the input will be noted where relevant. The publication provides benchmarks, policy update summaries, and clinical context to support coding accuracy and administrative understanding at a national level.
Billing Code Overview
CPT code 45135 describes a combined abdominal and perineal surgical procedure to excise a rectal procidentia (rectal prolapse) and reestablish continuity by connecting the colon to the remaining rectum. This procedure involves both abdominal and perineal approaches, reflecting a dual-access operative strategy to remove the prolapsed rectal segment and perform an anastomosis.
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Service Type: Surgical excision of rectal procidentia with colorectal anastomosis using combined abdominal and perineal approach
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Typical Site of Service: Inpatient or outpatient hospital surgical setting (operating room), with preoperative and postoperative care in hospital or ambulatory surgery center depending on clinical factors
Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult presenting with symptomatic rectal procidentia (full-thickness rectal prolapse) characterized by visible protrusion through the anal canal, fecal incontinence, obstructed defecation, mucous discharge, and intermittent rectal bleeding. Conservative measures (stool softeners, pelvic floor therapy) have failed and the surgeon recommends definitive surgical repair.
Preoperative workflow includes colonoscopy or flexible sigmoidoscopy to exclude colonic pathology, anorectal physiology testing as indicated, and imaging when necessary. The procedure is performed under general anesthesia with combined abdominal and perineal approaches: abdominal mobilization of the sigmoid colon and rectum with fixation (resection and anastomosis as needed) and perineal resection of redundant rectal tissue; the colon is anastomosed to the remaining rectum. Typical sites of service are an inpatient acute care hospital or ambulatory surgery center when appropriate. Postoperative care includes pain control, DVT prophylaxis, bowel regimen, wound care, and outpatient follow-up for functional outcomes and stool continence assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard claim submission | Use for routine, uncomplicated reporting when no modifier applies |