CPT 45172 Transanal Excision Reimbursement | OpenPayer

Summary & Overview

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

CPT code 45172 documents a transanal excision of a rectal tumor that includes removal of the muscularis propria. This surgical code is used when a provider performs a full-thickness excision of a rectal lesion through the anus, and it is relevant to colorectal surgery, surgical oncology, and ambulatory surgical services. Nationally, accurate coding for 45172 affects surgical case classification, quality reporting, and appropriate payer adjudication for rectal tumor management.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage practices, typical site-of-service considerations, and coding nuances that impact claims processing.

Readers will learn: the clinical context and procedure elements represented by 45172; where the procedure is typically performed; common billing and documentation points to support surgical intent and full-thickness excision; and benchmark topics and policy updates relevant to surgical coding and payer coverage. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45172CPTtransanal excisionrectal tumorcolorectal surgerysurgical codingambulatory surgerysurgical oncology

Billing Code Overview

CPT code 45172 describes a transanal excision of a rectal tumor that includes removal of the muscularis propria. The procedure is performed through the anus via a transanal approach and entails a rectal incision to excise the lesion.

Service type: Surgical procedure — transanal excision of rectal tumor

Typical site of service: Ambulatory surgical center or hospital operating room; performed via transanal access

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old individual presenting with rectal bleeding and a palpable rectal mass on digital rectal exam. Endoscopic evaluation (flexible sigmoidoscopy or colonoscopy) identifies a localized T1–T2 lesion within the distal rectum accessible via transanal approach. Biopsy demonstrates a benign adenoma with high-grade dysplasia or a small early-stage adenocarcinoma confined to the rectal wall. After preoperative staging (endorectal ultrasound or pelvic MRI) confirms a lesion amenable to local excision and the patient is counseled regarding options, the surgeon schedules a transanal excision.

On the day of service, the procedure is performed in an ambulatory surgery center or hospital operating room with the patient under regional or general anesthesia. The surgeon uses a transanal approach through the anus, makes a full-thickness excision including the muscularis propria to achieve clear margins, and sends the specimen for pathologic evaluation. Intraoperative measures include local hemostasis, assessment of the defect (which may be closed primarily or left open depending on size and location), and documentation of specimen size and margin status. Postoperative care includes monitoring for bleeding, infection, and signs of rectal wall compromise, with instructions for bowel regimen and follow-up for final pathology to determine need for further therapy.

Coding Specifications

Modifier	Description	When to Use
`00`	Not defined by CMS for claims use (placeholder)

CPT 45116: Posterior Rectal Resection with Colorectal Anastomosis

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

CPT 45112: Rectal Resection with Colonic Anastomosis to Anus

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

CPT 45123: Perineal Resection of Diseased Rectum, No Anastomosis

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

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

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

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

CPT-45110-ABDOMINOPERINEAL-RESECTION-WITH-COLOSTOMY

CPT 45110: Abdominoperineal Resection with Colostomy

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

CPT 45119: Restorative Proctocolectomy with Colonic Pouch

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

CPT 45111: Partial Rectal Resection, Abdominal Approach

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

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

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

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

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Taxonomy Code	Specialty	Notes
`General Surgery`	General Surgery	Most common specialty performing transanal full-thickness excision in community hospitals and ambulatory surgical centers.
`Colorectal Surgery`	Colon & Rectal Surgery	Specialists with focused expertise in transanal excisions and decision-making for local excision vs radical resection.
`Gastroenterology`	Gastroenterology	May perform transanal endoscopic procedures or contribute to diagnosis and endoscopic management; less commonly performs full-thickness transanal excision.
`Surgical Oncology`	Surgical Oncology	In tertiary centers, oncologic surgeons may perform or co-manage when malignancy is suspected.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.5`	Rectal polyp	Benign polypoid lesions that may be treated with local excision when accessible transanally.
`D12.6`	Benign neoplasm of rectum	Adenomatous polyps or benign tumors that may require full-thickness transanal excision for complete removal.
`C20`	Malignant neoplasm of rectum	Early-stage rectal adenocarcinoma potentially amenable to local excision if superficial and well‑selected.
`K62.0`	Anal fissure	Not a primary indication for full-thickness excision but part of anorectal differential diagnoses during evaluation.
`K62.9`	Disease of anus and rectum, unspecified	Used when a more specific diagnosis is pending pathology; interim coding for encounter documentation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45330`	Flexible sigmoidoscopy, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Performed preoperatively for diagnosis and lesion mapping prior to planning a transanal excision.
`45380`	Colonoscopy with biopsy, single or multiple	Diagnostic colonoscopy with biopsy that often precedes surgical excision to establish pathology.
`46600`	Closure of rectal prolapse, external, simple (may vary)	Not routinely performed with transanal excision but listed as related anorectal procedures in pre/postoperative considerations when anatomy is altered.
`44140`	Colectomy, partial; with anastomosis (resection, small intestine, large intestine)	Represents a more extensive resection reserved when local excision is inadequate or for higher-stage malignancy; may follow if pathology shows deeper invasion.
`45395`	Endoscopic mucosal resection (EMR) or polypectomy for colon/rectum, single session	Alternative minimally invasive treatment for select lesions amenable to endoscopic resection rather than full-thickness transanal excision.

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