Summary & Overview
CPT 45400: Laparoscopic Repair of Rectal Prolapse with Sutures and Mesh
CPT code 45400 represents a laparoscopic surgical procedure to repair rectal prolapse with sutures and mesh. This code captures a minimally invasive approach to restore pelvic support and reduce prolapse symptoms. Nationally, procedures for rectal prolapse are significant due to an aging population and increasing use of minimally invasive surgical techniques that affect utilization, care pathways, and facility planning.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for CPT code 45400, common sites of service, and how this service is typically classified. The publication summarizes payer coverage considerations, typical billing modifiers used with surgical laparoscopy, and expected coding relationships. It also outlines benchmarking topics such as utilization patterns, allowed amounts, and site-of-service distribution where available.
This resource is intended to inform coding, billing, and administrative staff, as well as clinicians and policy analysts, about the procedural definition, operational settings, and areas to monitor for reimbursement and policy updates. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 45400 describes a laparoscopic repair of rectal prolapse using sutures and mesh. The procedure involves surgical correction of rectal prolapse through minimally invasive (laparoscopic) techniques with placement of sutures and prosthetic mesh to restore pelvic support.
Service Type: Surgical — Laparoscopic pelvic surgery
Typical Site of Service: Hospital outpatient department or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 68-year-old female presents with symptomatic full-thickness rectal prolapse characterized by fecal urgency, mucous discharge, and a reducible protrusion during Valsalva. Conservative measures including pelvic floor physical therapy and stool softeners have failed. The colorectal surgeon schedules a laparoscopic rectopexy with mesh reinforcement under general anesthesia. Preoperative steps include colonoscopy (to exclude synchronous lesions), bowel prep per facility protocol, and medical optimization for comorbidities (hypertension, type 2 diabetes). Intraoperatively, the abdomen is insufflated, laparoscopic ports are placed, the rectum is mobilized, posterior sutures are placed to pex the rectum to the sacral promontory, and a biologic or synthetic mesh is affixed laparoscopically to reinforce the repair. The patient is monitored post-anesthesia in a same-day surgery unit or admitted overnight for pain control and return of bowel function. Typical follow-up includes wound checks and evaluation of bowel and continence function at 2–6 weeks and long-term surveillance for recurrence or mesh-related complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Applied when no additional modifier is appropriate for the claim |
22 |