Summary & Overview
CPT 45540: Abdominal Rectopexy for Rectal Prolapse
Headline: New Profile — CPT code 45540 captures abdominal rectopexy with mesh and sutures for rectal prolapse
Lead: CPT code 45540 identifies a surgical repair of rectal prolapse performed through a lower abdominal incision using sutures and mesh. The code denotes an operative abdominal rectopexy approach and is relevant to surgeons, hospital billing teams, and national payers managing coverage for colorectal surgical care.
Why it matters: Rectal prolapse procedures are resource-intensive operations with implications for inpatient utilization, device use (mesh), and postoperative care. Accurate coding of abdominal rectopexy affects claim adjudication, quality reporting, and aggregated procedure volumes nationwide.
Payers covered: Analysis includes major national payers — Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides benchmarks and context for CPT code 45540 including national utilization patterns, expected sites of service, and clinical context for abdominal rectopexy using mesh and sutures. It summarizes payer coverage considerations and common billing modifiers where available. Policy updates, reimbursement trends, and clinical indications that influence coding for rectal prolapse repair are presented to inform billing accuracy and administrative planning.
Scope: Content is written for a national audience of clinicians, billing professionals, and policy analysts seeking concise, operational guidance about coding and payer considerations for abdominal rectopexy with mesh.
Billing Code Overview
CPT code 45540 describes a surgical procedure in which the provider makes an incision in the lower abdomen to repair rectal prolapse using sutures and mesh. This is an abdominal approach for rectopexy, classically performed to restore normal anatomic position of the rectum and reduce symptoms related to prolapse.
Service Type: Surgical — Abdominal rectopexy with mesh and suturing
Typical Site of Service: Inpatient hospital or ambulatory surgical center, depending on patient condition and care setting.
Clinical & Coding Specifications
Clinical Context
A 68-year-old female with a symptomatic full-thickness rectal prolapse presents for elective operative repair. She reports fecal urgency, mucous discharge, and difficulty with hygiene. Conservative measures including stool softeners and pelvic floor therapy provided partial relief. Preoperative evaluation includes colonoscopy to exclude intraluminal disease, cardiopulmonary assessment, and bowel preparation as indicated. The patient is scheduled for an open abdominal rectopexy with mesh reinforcement under general anesthesia. Intraoperative workflow: midline or lower transverse abdominal incision is made, rectum is mobilized, redundant rectum is reduced, sutures placed to suspend the rectum to the presacral fascia, and a surgical mesh is affixed to reinforce the repair. Hemostasis is confirmed, bowel viability assessed, and abdomen closed in layers. Postoperative care includes pain control, DVT prophylaxis, early ambulation, stool regimen to avoid constipation, and wound monitoring. Typical site of service is an inpatient hospital operating room or ambulatory surgery center for selected low-risk patients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no additional modifier applies to the service |
22 |