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    v1.0.30
    OpenPayerBilling CodesExcisional Laparoscopic Procedures on the RectumCPT cpt-45397-laparoscopic-proctocolectomy-coloanal-anastomosis-colonic-pouch
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    CPT 45397: Laparoscopic Restorative Proctocolectomy with Ileoanal Pouch

    Medicare pays $1970 on average nationally for this procedure.

    CPT code 45397 describes a laparoscopic restorative proctocolectomy with coloanal anastomosis and creation of a colonic pouch for fecal reservoir; the procedure may include a temporary diverting ileostomy. Service type: laparoscopic major colorectal surgery. Typical site of service: hospital inpatient or ambulatory surgery center for definitive colectomy and pouch reconstruction under general anesthesia.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 45–65-year-old adult with refractory ulcerative colitis, familial adenomatous polyposis, or low rectal cancer requiring proctocolectomy with restorative ileoanal-pouch formation. The patient presents after failing medical therapy or following a surgical oncology decision for oncologic resection. Preoperative workup includes colonoscopy, cross-sectional imaging, and routine labs. The operation is performed in an operating room under general anesthesia using laparoscopic techniques. The surgeon mobilizes and removes the entire rectum (proctectomy), constructs a colonic reservoir (colonic J-pouch or similar), performs a coloanal anastomosis, and may create a temporary diverting ileostomy to protect the anastomosis.

    Perioperative workflow: preoperative consent and marking, anesthesia induction, prophylactic antibiotics, laparoscopic abdominal access, mesenteric vessel division and rectal mobilization, pouch construction and transanal anastomosis, leak test, possible creation of a loop ileostomy through a separate abdominal incision, closure of laparoscopic port sites, postoperative recovery in PACU and inpatient monitoring for bowel function, stoma care education if an ileostomy is created, and planned outpatient follow-up with possible staged ileostomy closure in 8–12 weeks if applicable.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44204Laparoscopy, surgical; colectomy, partial, with anastomosisMay be performed when segmental colectomy is required in addition to pouch creation or for proximal disease management.

    | 44140 | Colectomy, partial; with anastomosis, for benign or malignant disease, open procedure | An open alternative when laparoscopy is not feasible; may be billed instead of or in combination depending on approach.

    | 44625 | Partial proctectomy with anastomosis (coloanal) | Related pelvic dissection/anastomotic technique codes when proctectomy components are reported separately.

    | 44180 | Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy | May be performed in staged management where total colectomy precedes restorative pouch creation.

    | 44187 | Colectomy, total, with proctectomy, with ileostomy | Codes for total proctocolectomy with stoma creation when pouch reconstruction is not performed during the same operation.

    | 44227 | Laparoscopy, surgical; colectomy, total, abdominal, combined with proctectomy | Laparoscopic total proctocolectomy codes that may be used for variant approaches to rectal removal and pouch formation.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    58Modifier 58 (Staged or related procedure/service by the same physician during the postoperative period) indicates that a subsequent procedure performed by the same provider during the…- Use modifier 58 when the same physician/QHP performs a procedure during the postoperative/global period of an earlier procedure and the subsequent procedure is either planned or anticipated…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207K00000X
    208000000X
    207RH0000X
    332G00000X
    163WH0200X
    261QM2500X
    207RN0300X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    C20Malignant neoplasm of rectum
    C21.0Malignant neoplasm of anus, unspecified
    C21.8Malignant neoplasm of overlapping sites of rectum, anus and anal canal
    K50.012Crohn's disease of small intestine with intestinal obstruction
    K50.111Crohn's disease of large intestine with rectal bleeding
    K50.112Crohn's disease of large intestine with intestinal obstruction
    K51.412Inflammatory polyps of colon with intestinal obstruction
    K51.413Inflammatory polyps of colon with fistula
    K51.812Other ulcerative colitis with intestinal obstruction
    K51.814Other ulcerative colitis with abscess

    Showing 1–10 of 29

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-45395-LAPAROSCOPIC-TOTAL-PROCTECTOMY-END-COLOSTOMY

    CPT 45395: Laparoscopic Proctectomy with Colostomy

    CPT-45398-COLONOSCOPY-BAND-LIGATION-HEMORRHOID

    CPT 45398: Flexible Colonoscopy with Band Ligation

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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