CPT 45402 Laparoscopic Rectopexy Reimbursement | OpenPayer

Summary & Overview

CPT 45402: Laparoscopic Sigmoid Resection with Rectal Prolapse Repair

CPT code 45402 represents a laparoscopic colorectal surgical procedure combining sigmoid colon resection with repair of rectal prolapse using sutures and mesh. This operative approach addresses both structural pelvic support and colonic pathology in a single minimally invasive session, with implications for perioperative resource use, surgical outcomes, and payer reimbursement patterns nationwide. The code matters nationally because it captures a complex, often resource-intensive operation that intersects surgical, anesthesia, and facility billing considerations.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of billing benchmarks and common payer coverage patterns, a concise summary of the clinical context for the combined resection and prolapse repair, and notes on sites of service and procedural classification relevant to coding and claims submission. The publication highlights typical service settings, expected procedural components, and areas where policy updates or payer-specific rules commonly affect payment and prior authorization requirements. Data limitations: Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 45402laparoscopic colorectal surgeryrectal prolapse repairsigmoid resectionsurgical procedure codingminimally invasive surgeryoperative repair with meshcolorectal surgerybilling and coding

Billing Code Overview

CPT code 45402 describes a laparoscopic procedure that treats rectal prolapse and removes a portion of the sigmoid colon, with repairs performed using sutures and mesh. The procedure combines resection of sigmoid colon tissue with pelvic support reconstruction to address both the prolapse and associated colonic pathology.

Service Type: Laparoscopic colorectal surgical procedure

Typical Site of Service: Inpatient or outpatient surgical center with laparoscopic capability; operating room

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old female with symptomatic full-thickness rectal prolapse and recurrent obstructive defecation presents for surgical repair. She reports fecal incontinence, a sensation of a bulge per rectum, and multiple failed conservative measures including pelvic floor therapy and stool regimen optimization. Preoperative evaluation includes colonoscopy to rule out synchronous colorectal pathology, cardiopulmonary assessment for anesthesia clearance, and informed consent discussing laparoscopic rectopexy with sigmoid resection and mesh reinforcement.

In the operating room under general anesthesia, the colorectal surgeon performs a laparoscopic mobilization of the sigmoid colon, resection of a redundant sigmoid segment, and rectal mobilization. The rectum is reduced and secured to the presacral fascia with sutures and prosthetic mesh to prevent recurrent prolapse. Laparoscopic anastomosis is created and intraoperative leak testing is performed. The patient is observed in PACU and admitted for short inpatient recovery with bowel regimen management, pain control, and discharge planning for routine postoperative follow-up and wound care.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier; standard reporting	Use when no special circumstances apply and primary procedure is reported without modifier.

CPT 45499: Laparoscopic Rectal Procedure, Unlisted

CPT-45400-LAPAROSCOPIC-REPAIR-RECTAL-PROLAPSE-SUTURES-MESH

CPT 45400: Laparoscopic Repair of Rectal Prolapse with Sutures and Mesh

Taxonomy Code	Specialty	Notes
207R00000X	Colon & Rectal Surgery	Primary specialty performing laparoscopic rectopexy with sigmoid resection.
207L00000X	General Surgery	Common specialty performing colorectal resections and pelvic repair.
2080P0003X	Gynecology	Occasional specialty involved when pelvic floor support procedures are concurrently addressed.
207VG0400X	Surgical Oncology	Involved when resection is performed for neoplastic disease or suspicious lesions.
363LA2200X	Anesthesiology	Perioperative specialty providing general anesthesia and intraoperative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.3`	Rectal prolapse	Primary indication for rectopexy and often for combined sigmoid resection when redundancy exists.
`K57.30`	Diverticulosis of large intestine without perforation or abscess	May coexist with sigmoid redundancy necessitating resection during prolapse repair.
`K59.0`	Constipation, unspecified	Common symptom leading to surgery when conservative measures fail and redundant sigmoid contributes to obstruction.
`K64.8`	Other hemorrhoids	Hemorrhoidal disease frequently coexists and can be addressed during anorectal procedures.
`R15.0`	Incomplete defecation	Symptom reflecting obstructive defecation syndrome associated with rectal prolapse.
`R15.9`	Full incontinence of feces	Fecal incontinence is a common functional indication for rectopexy with or without sigmoid resection.
`C18.9`	Malignant neoplasm of colon, unspecified	If neoplasm is identified preoperatively, oncologic resection principles apply; may alter coding and operative approach.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45378`	Colonoscopy, flexible, proximal to splenic flexure; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Preoperative diagnostic evaluation to exclude proximal pathology before elective resection.
`44204`	Laparoscopy, surgical, colectomy, partial; with anastomosis, for example, for sigmoidectomy	Closely related laparoscopic partial colectomy code; may be used if coding focuses on the colectomy component rather than combined rectopexy description.
`49568`	Implantation of mesh or other prosthesis for ventral, incisional or ventral hernia (laparoscopic) — (representative of mesh placement technique)	Reflects use of mesh prosthesis during pelvic soft-tissue reinforcement; technique parallels prosthetic placement coding considerations.
`51702`	Injection procedure for urinary retention (e.g., suprapubic catheter or cystostomy) — example of concomitant urinary procedures	May be performed concurrently if urinary diversion or catheterization is required perioperatively.
`99024`	Postoperative follow-up visit global period, related to the surgical procedure	Used for reporting routine postoperative global period care and follow-up management after `45402`.

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