Summary & Overview
CPT 45136: Removal of Ileoanal Reservoir and Creation of Ileostomy
Headline: CPT code 45136: Ileostomy Creation After Ileoanal Reservoir Removal
Lead: CPT code 45136 identifies the surgical removal of an ileoanal reservoir with formation of an ileostomy, a significant reconstructive colorectal procedure that alters bowel diversion and long-term bowel management.
CPT code 45136 represents a major colorectal surgical intervention in which an internal ileoanal pouch is dismantled and the ileum is brought to the abdominal wall as an ostomy. This operation matters nationally because it affects postoperative care pathways, stoma management resources, and inpatient surgical utilization metrics. It also has implications for payer coverage policies and bundled payment arrangements for complex colorectal surgery.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and care setting, common modifier usage noted in administrative practice, and what to expect for coding grouping and service line classification. The publication outlines national benchmarking areas such as utilization patterns, site-of-service considerations, and typical surgical service lines for this code. Policy updates and payer-specific coverage variations are summarized where available.
This summary provides clinicians, coding professionals, and policy analysts with a concise reference to the clinical meaning and administrative implications of CPT code 45136, and orients readers to the sections that follow for detail on billing, documentation points, and related service considerations.
Billing Code Overview
CPT code 45136 describes the surgical removal of an ileoanal reservoir with creation of an ileostomy, in which the terminal small intestine (ileum) is diverted through an abdominal opening. The procedure is performed when an existing internal pouch constructed from small bowel (ileoanal reservoir) is taken down and intestinal continuity is diverted to an abdominal stoma.
Service type: Surgical — Abdominal/Colorectal procedure
Typical site of service: Inpatient hospital or ambulatory surgical center (operating room)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a previously constructed ileoanal reservoir (J-pouch) after proctocolectomy for ulcerative colitis or familial adenomatous polyposis who now presents with chronic pelvic sepsis, refractory pouchitis, pouch failure, chronic fistula, mechanical dysfunction, or neoplasia of the pouch. The patient has ongoing symptoms such as persistent pain, drainage, recurrent infections, poor pouch emptying, or loss of continence despite medical and endoscopic therapy. The surgical team evaluates the patient with history, physical exam, pouchoscopy, cross-sectional imaging (CT or MRI pelvis), and labs. After multidisciplinary review and informed consent, the operative plan is to explant the ileoanal reservoir and create a permanent end ileostomy with exteriorization of the terminal ileum through an abdominal stoma site. The procedure may be performed under general anesthesia in an operating room at an inpatient hospital or ambulatory surgical center depending on acuity and comorbidities. Typical workflow includes preoperative marking of the stoma site by enterostomal therapy nursing, administration of prophylactic antibiotics, mobilization and takedown of the pouch with control of mesentery and mesenteric vessels as needed, resection of the reservoir, mucosectomy or anastomotic revision if present, and maturation of the ileostomy. Postoperative care includes stoma care education, analgesia, monitoring for complications (bleeding, infection, small-bowel obstruction, dehydration), and coordination with enterostomal therapy and outpatient follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |