Summary & Overview
CPT 45550: Open Rectopexy with Sigmoid Resection
CPT code 45550 represents an open abdominal rectopexy with repair of rectal prolapse using sutures and mesh combined with resection of a redundant sigmoid colon. This operative code captures a definitive surgical approach to symptomatic rectal prolapse and associated redundant sigmoid that often requires hospital-based operative care. Nationally, procedures for rectal prolapse are significant for surgical coloproctology caseloads and can affect inpatient surgical utilization, perioperative resource allocation, and postoperative quality measures.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides clinicians, coding professionals, and policy analysts with clinical context for the procedure, coding specifics for billing and claims submission, and a synthesis of benchmarking and policy considerations where available. Readers will find: a clinical summary of the operative service captured by 45550; typical sites of service and expected care setting; common billing modifiers and claims considerations; and guidance on areas where payer policies and coverage rules commonly influence authorization and reimbursement. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 45550 describes an open abdominal procedure for correction of rectal prolapse that includes fixation with sutures and mesh and resection of the redundant sigmoid colon. The procedure involves a lower abdominal incision, reduction and repair of the prolapse, placement or fixation of prosthetic mesh as indicated, and sigmoid colectomy with resection of the redundant segment.
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Service type: Abdominal surgical repair with colorectal resection
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Typical site of service: Inpatient or outpatient hospital operating room, depending on clinical complexity and postoperative needs
Clinical & Coding Specifications
Clinical Context
A 68-year-old female presents with symptomatic full‑thickness rectal prolapse characterized by fecal urgency, mucous discharge, and partial obstruction. Conservative measures including pelvic floor therapy and stool regimen failed. Preoperative evaluation includes colonoscopy to exclude mucosal lesions, cross‑sectional imaging if indicated, and routine preoperative labs and anesthesia assessment. The surgeon plans an open abdominal rectopexy with sigmoid resection to correct the prolapse, fix the rectum to the presacral fascia with sutures and prosthetic mesh, and perform a sigmoid colectomy to remove redundant colon and reduce recurrence risk. The procedure is performed in an inpatient operating room under general anesthesia with postoperative monitoring on a surgical ward; typical recovery includes bowel function monitoring, pain control, deep venous thrombosis prophylaxis, early ambulation, and discharge planning in 3–5 days if uncomplicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified procedure code | Rarely used in outpatient claims; indicates no modifier required |
11 | Office/Outpatient (default) | Use to indicate a standard procedural service when payer requires site modifier |