CPT 45171 Transanal Excision Reimbursement | OpenPayer

Summary & Overview

CPT 45171: Transanal Local Excision of Rectal Tumor

CPT code 45171 denotes a transanal local excision of a rectal tumor in which the excision does not extend into the muscularis propria. This code captures a focused surgical procedure used to remove superficial rectal lesions via an anal approach and is relevant for colorectal surgery, oncology care coordination, and surgical quality measurement nationally. Payers commonly involved in coverage determinations for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise clinical and billing overview of CPT code 45171, explaining the clinical context of transanal tumor excision, typical sites of service (ambulatory surgical centers and hospital operating rooms), and the service type (surgical excision via transanal approach). Readers will find benchmarks and payment context where available, relevant coding considerations, and policy or coverage updates that affect utilization and claims processing. The content is intended for coding professionals, surgical practices, compliance officers, and payer policy analysts seeking a national perspective on coding, documentation expectations, and payer coverage patterns. Data not available in the input will be indicated as such in the detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45171CPTtransanal excisionrectal surgerylocal excisionsurgical codingambulatory surgerycolorectal oncology

Billing Code Overview

CPT code 45171 describes a transanal excision of a rectal tumor where the incision and excision are performed through the anus and do not include the muscularis propria. This procedure is a local excision of a rectal lesion performed via a transanal approach.

Service type: Surgical excision (transanal local excision)
Typical site of service: Ambulatory surgical center or hospital operating room, performed via transanal approach

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents with a small, benign-appearing rectal polyp located within 8 cm of the anal verge. The lesion is assessed by a colorectal surgeon during an outpatient evaluation after fecal occult blood testing and flexible sigmoidoscopy identified a raised lesion. Under monitored anesthesia care in an ambulatory surgery center, the surgeon performs a transanal excision through the anal canal, removing the lesion without entering the muscularis propria (full-thickness layer). Intraoperative steps include lesion localization, local infiltration with anesthetic and epinephrine for hemostasis, mucosal and submucosal incision, sharp and/or blunt dissection to remove the tumor, and hemostasis with cautery or suture as needed. The specimen is sent to pathology for histologic evaluation. Typical perioperative documentation includes preoperative diagnosis, procedure note specifying a transanal approach and that the excision did not include muscularis propria, estimated blood loss, anesthesia type, and disposition. Typical site of service is an ambulatory surgery center or hospital outpatient surgery department for short-stay procedures.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical for the procedure (requires documentation of increased work).

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

CPT-45135-RECTAL-PROCIDENTIA-EXCISION-ABDOMINAL-PERINEAL-ANASTOMOSIS

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

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

CPT 45119: Restorative Proctocolectomy with Colonic Pouch

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

CPT 45100: Anal Approach Biopsy of Anorectal Wall

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

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

CPT-45123-PERINEAL-RECTAL-RESECTION-WITHOUT-ANASTOMOSIS

CPT 45123: Perineal Resection of Diseased Rectum, No Anastomosis

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

CPT 45121: Pull-Through Resection with Colorectal Anastomosis

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

CPT 45113: Partial Proctectomy with Ileoanal Anastomosis and Ileal Pouch

CPT-45150-RECTAL-STRICTURE-INCISION

CPT 45150: Incision of Rectal Stricture

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

CPT 45116: Posterior Rectal Resection with Colorectal Anastomosis

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Taxonomy Code	Specialty	Notes
2080S0101X	Colorectal Surgery	Primary specialty performing transanal excision procedures.
207R00000X	General Surgery	General surgeons frequently perform transanal excisions in community settings.
207VC0000X	Vascular Surgery	Data not available in the input.
2086S0101X	Colon and Rectal Surgery	Alternate taxonomy for colorectal-focused providers.
208000000X	Surgery	Broad surgery taxonomy for hospitals and ambulatory settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.5`	Hemorrhage of anus and rectum	May present in patients with rectal tumors causing bleeding; evaluation can lead to excision.
`K62.1`	Anal fissure	Distinct anorectal pathology that may be part of differential diagnosis for anorectal pain; not an indication for this excision unless concurrent lesion present.
`D12.6`	Benign neoplasm of rectum	Common indication for local excision when lesion is benign and limited to mucosa/submucosa.
`K62.9`	Disease of anus and rectum, unspecified	Nonspecific diagnosis code sometimes used pending definitive pathology.
`C20`	Malignant neoplasm of rectum	When invasive malignancy is suspected, transanal excision may be diagnostic or therapeutic for select low-risk T1 lesions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45330`	Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing	Often performed preoperatively to identify lesion location and characterize mucosa prior to transanal excision.
`44140`	Colectomy, partial; with anastomosis	A more extensive procedure reserved for lesions that cannot be managed by transanal excision or when full-thickness resection is required.
`44145`	Colectomy, partial; with coloproctostomy (low pelvic anastomosis)	Performed when lesion or pathology necessitates segmental rectal resection beyond transanal approach.
`45385`	Endoscopic mucosal resection (EMR) or polypectomy, single or multiple, any method; colon	Alternative endoscopic approach for select superficial rectal lesions that may avoid surgical transanal excision.
`88305`	Surgical pathology, gross and microscopic examination, intermediate complexity	Used for histopathologic evaluation of the excised lesion to establish diagnosis and margin status.

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