Summary & Overview
CPT 45505: Excision of Prolapsed Rectal Mucosa with Flap Repair
CPT code 45505 covers excision of prolapsed rectal mucosa with repair using adjacent tissue flaps, a reconstructive anorectal surgical procedure. This code is used for definitive surgical management of rectal mucosal prolapse and is relevant for hospitals and ambulatory surgical centers that provide colorectal and general surgery services. Nationally, proper coding of this procedure affects surgical quality reporting, facility reimbursement, and utilization tracking for anorectal reconstructive care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and payer coverage considerations. The publication also presents benchmarks for utilization and reimbursement patterns, outlines common billing modifiers used with operative procedures, and summarizes policy or coding updates that affect billing practice.
The content helps clinical coders, billing managers, and health policy analysts understand how CPT code 45505 is applied in practice, what documentation supports appropriate use, and where to look for payer-specific rules. Data not available in the input will be explicitly noted where applicable in detailed sections.
Billing Code Overview
CPT code 45505 describes a surgical procedure in which the provider excises prolapsed rectal mucosa and repairs the resulting defect using flaps of adjacent tissue. This procedure is a reparative anorectal surgery focused on removal of redundant or prolapsed mucosa and reconstruction to restore normal anatomy and function.
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Service type: Surgical excision and reconstructive flap repair of rectal mucosa (anorectal surgery)
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Typical site of service: Hospital operating room or ambulatory surgical center where operative anorectal procedures are performed
Clinical & Coding Specifications
Clinical Context
A 72-year-old female presents to colorectal surgery clinic with progressive full-thickness rectal prolapse causing fecal incontinence, mucous discharge, and rectal bleeding. After failed conservative measures (stool regulation, pelvic floor therapy) and confirmed diagnosis on physical exam and defecography, the surgeon schedules a transabdominal or perineal rectopexy with excision of redundant rectal mucosa and tissue flap repair to restore anatomy and continence. The typical workflow includes preoperative evaluation (history, labs, ECG if indicated), bowel preparation per surgeon preference, adminstration of general or regional anesthesia, intraoperative excision of prolapsed mucosa with adjacent tissue flaps to reconstruct the rectal wall, hemostasis, and layered closure. Postoperative care includes pain control, bowel regimen, activity restrictions, and outpatient follow-up for wound check and functional assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default; no modifier appended when no special circumstance applies |
22 | Unusual procedural services | Use when work required is substantially greater than typical for the procedure (extensive dissection, unexpected adhesions) |