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CPT 45395: Laparoscopic Total Proctectomy with End Colostomy

CPT code 45395 denotes a laparoscopic total proctectomy with creation of an end colostomy — a major colorectal surgical procedure used when removal of the entire rectum is required and a permanent stoma is created. This code captures a complex, operative intervention with significant implications for perioperative care, hospital resource use, and postoperative quality-of-life outcomes. Nationally, accurate coding for this procedure matters for inpatient surgical reimbursement, quality measurement, and tracking trends in minimally invasive colorectal surgery.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how CPT code 45395 is used across inpatient surgical settings, highlights typical clinical and billing considerations, and outlines common modifiers that may accompany reporting (Data not available in the input for payer-specific fee schedules).

Readers will find: concise clinical context for the procedure; expected site of service and service line framing; an explanation of why precise coding matters for case mix, post-acute planning, and quality reporting; and guidance on what information is available versus missing from the input. The piece is intended to support coding professionals, surgical program managers, and payers in understanding how CPT code 45395 fits into national surgical practice and billing workflows.

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Billing Code Overview

CPT code 45395 describes a laparoscopic total proctectomy with end colostomy (abdominoperineal resection with permanent colostomy). The procedure involves removal of the entire rectum using laparoscopic techniques, followed by exteriorization of the remaining colon and creation of a permanent stoma on the abdominal wall.

Service type: Surgical — laparoscopic colorectal resection with permanent ostomy

Typical site of service: Inpatient hospital operating room

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CPT 45395: Laparoscopic Total Proctectomy with End Colostomy

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Billing Code Overview

Service type: Surgical — laparoscopic colorectal resection with permanent ostomy

Typical site of service: Inpatient hospital operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old with locally advanced rectal adenocarcinoma who presents after neoadjuvant chemoradiation with persistent tumor involving the rectum and perirectal tissues. After multidisciplinary review, the surgical team schedules a planned laparoscopic abdominoperineal resection with end colostomy creation. The patient undergoes preoperative bowel preparation, anesthesia evaluation, and perioperative antibiotics. In the operating room, the colorectal surgeon performs a laparoscopic total proctectomy, mobilizes the sigmoid colon, divides the rectum and anus, and matures a permanent end colostomy on the abdominal wall. Postoperative workflow includes recovery in post-anesthesia care, pain management, early ambulation, ostomy teaching by Wound, Ostomy, and Continence (WOC) nurses, and inpatient monitoring for return of bowel function and wound healing. Typical sites of service are the inpatient hospital operating room and post-anesthesia/postoperative units. The service type is a major surgical procedure (laparoscopic proctectomy with colostomy) typically billed as surgical inpatient care.

Coding Specifications

Modifier	Description	When to Use
`00`	Default or unspecified modifier in some systems	Use only when no other modifier applies and payer requires a default; rarely used clinically.
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical proctectomy due to extensive adhesiolysis or multivisceral resection.
`23`	Unusual anesthesia	Use when anesthesia is medically contraindicated for standard techniques and an unusual alternative is used.
`26`	Professional component	Use when reporting only the surgeon’s professional component separate from facility charges (rare for global surgical CPTs).
`50`	Bilateral procedure	Not typically applicable; included when a bilateral approach or duplicate procedures are performed and payer requires notation.
`51`	Multiple procedures	Use when additional distinct procedures are performed during the same session (for example, synchronous hernia repair).
`52`	Reduced services	Use when the procedure is partially performed or aborted but still documented as reduced service.
`53`	Discontinued procedure	Use when the operation is started but discontinued due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure concurrently.
`66`	Surgical team	Use when a surgical team performs the operation under an approved team approach.
`78`	Unplanned return to OR after initial procedure	Use when the patient returns to the operating room for a related unplanned procedure during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon provides help during the procedure and the payer recognizes assistant fees.
`81`	Minimum assistant surgeon	Use when a minimal assistant is documented and payer allows reduced assistant payment.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant surgeon is required.

Taxonomy Code	Specialty	Notes
`207R00000X`	Colon and Rectal Surgery	Primary specialty performing this procedure.
`208800000X`	General Surgery	Common specialty performing laparoscopic proctectomy when colorectal specialists are unavailable.
`2080P0205X`	Surgical Oncology	Involved when cancer resection planning and multivisceral resection are required.
`207L00000X`	Thoracic & Thoracic Surgery (not typical)	Not typical; listed only if multilevel thoracoabdominal approach is necessary.
`2084P0800X`	Acute Care Surgery	May perform in emergent settings for perforation or sepsis requiring resection.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C20`	Malignant neoplasm of rectum	Primary oncologic indication for total proctectomy with permanent colostomy.
`K62.5`	Hemorrhage of anus and rectum	May occur with severe local disease prompting surgical resection in emergent scenarios.
`K62.5` (alternative acute presentation)	Fecal incontinence (use `R15` for incontinence)	Situations with uncontrolled local disease or sphincter destruction may necessitate abdominoperineal resection.
`K63.1`	Perforation of intestine (nontraumatic)	Bowel perforation with sepsis may require emergent removal of the rectum and stoma formation.
`K57.2`	Diverticulitis of large intestine with perforation and abscess	Complicated diverticulitis involving the rectum or distal sigmoid may lead to proctectomy and colostomy.
`K91.3`	Postoperative intestinal obstruction	Relevant as a postoperative complication; may necessitate reoperation related to the index procedure.
`Z90.49`	Acquired absence of other organs, not elsewhere classified (colostomy status)	Used after creation of a permanent colostomy to document altered anatomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44143`	Colectomy, partial; with colostomy or ileostomy (separate procedure)	May be performed if additional proximal colon resection is required or as part of an extended oncologic colectomy.
`44204`	Laparoscopy, surgical; colectomy, partial, with colostomy or ileostomy	Laparoscopic partial colectomy codes apply when resections extend proximally and a stoma is created via minimally invasive approach.
`49650`	Closure of enterostomy; complicated	May be billed in a later admission when the colostomy is reversed (closure), if indicated.
`44625`	Closure of partial colectomy with primary anastomosis	Applies when restoration of intestinal continuity is performed in a subsequent surgery instead of permanent colostomy.
`99223`	Initial hospital care, typically 70 minutes or more	Typical inpatient evaluation and management code for preoperative or immediate postoperative complex medical care for major surgery.

CPT 45397: Laparoscopic Proctocolectomy with Coloanal Anastomosis and Colonic Pouch

CPT-45398-COLONOSCOPY-BAND-LIGATION-HEMORRHOID

CPT 45398: Band Ligation During Flexible Colonoscopy

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	Default or unspecified modifier in some systems	Use only when no other modifier applies and payer requires a default; rarely used clinically.
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical proctectomy due to extensive adhesiolysis or multivisceral resection.
`23`	Unusual anesthesia	Use when anesthesia is medically contraindicated for standard techniques and an unusual alternative is used.
`26`	Professional component	Use when reporting only the surgeon’s professional component separate from facility charges (rare for global surgical CPTs).
`50`	Bilateral procedure	Not typically applicable; included when a bilateral approach or duplicate procedures are performed and payer requires notation.
`51`	Multiple procedures	Use when additional distinct procedures are performed during the same session (for example, synchronous hernia repair).
`52`	Reduced services	Use when the procedure is partially performed or aborted but still documented as reduced service.
`53`	Discontinued procedure	Use when the operation is started but discontinued due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure concurrently.
`66`	Surgical team	Use when a surgical team performs the operation under an approved team approach.
`78`	Unplanned return to OR after initial procedure	Use when the patient returns to the operating room for a related unplanned procedure during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon provides help during the procedure and the payer recognizes assistant fees.
`81`	Minimum assistant surgeon	Use when a minimal assistant is documented and payer allows reduced assistant payment.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant surgeon is required.

Taxonomy Code	Specialty	Notes
`207R00000X`	Colon and Rectal Surgery	Primary specialty performing this procedure.
`208800000X`	General Surgery	Common specialty performing laparoscopic proctectomy when colorectal specialists are unavailable.
`2080P0205X`	Surgical Oncology	Involved when cancer resection planning and multivisceral resection are required.
`207L00000X`	Thoracic & Thoracic Surgery (not typical)	Not typical; listed only if multilevel thoracoabdominal approach is necessary.
`2084P0800X`	Acute Care Surgery	May perform in emergent settings for perforation or sepsis requiring resection.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C20`	Malignant neoplasm of rectum	Primary oncologic indication for total proctectomy with permanent colostomy.
`K62.5`	Hemorrhage of anus and rectum	May occur with severe local disease prompting surgical resection in emergent scenarios.
`K62.5` (alternative acute presentation)	Fecal incontinence (use `R15` for incontinence)	Situations with uncontrolled local disease or sphincter destruction may necessitate abdominoperineal resection.
`K63.1`	Perforation of intestine (nontraumatic)	Bowel perforation with sepsis may require emergent removal of the rectum and stoma formation.
`K57.2`	Diverticulitis of large intestine with perforation and abscess	Complicated diverticulitis involving the rectum or distal sigmoid may lead to proctectomy and colostomy.
`K91.3`	Postoperative intestinal obstruction	Relevant as a postoperative complication; may necessitate reoperation related to the index procedure.
`Z90.49`	Acquired absence of other organs, not elsewhere classified (colostomy status)	Used after creation of a permanent colostomy to document altered anatomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44143`	Colectomy, partial; with colostomy or ileostomy (separate procedure)	May be performed if additional proximal colon resection is required or as part of an extended oncologic colectomy.
`44204`	Laparoscopy, surgical; colectomy, partial, with colostomy or ileostomy	Laparoscopic partial colectomy codes apply when resections extend proximally and a stoma is created via minimally invasive approach.
`49650`	Closure of enterostomy; complicated	May be billed in a later admission when the colostomy is reversed (closure), if indicated.
`44625`	Closure of partial colectomy with primary anastomosis	Applies when restoration of intestinal continuity is performed in a subsequent surgery instead of permanent colostomy.
`99223`	Initial hospital care, typically 70 minutes or more	Typical inpatient evaluation and management code for preoperative or immediate postoperative complex medical care for major surgery.

CPT 45397: Laparoscopic Proctocolectomy with Coloanal Anastomosis and Colonic Pouch

CPT-45398-COLONOSCOPY-BAND-LIGATION-HEMORRHOID

CPT 45398: Band Ligation During Flexible Colonoscopy

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 45395: Laparoscopic Total Proctectomy with End Colostomy

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Billing Code Overview

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CPT 45395: Laparoscopic Total Proctectomy with End Colostomy

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References