Summary & Overview

CPT 45563: Rectal Injury Repair with Sigmoid Colostomy

CPT code 45563 denotes a complex abdominal surgical procedure involving exploration of the lower abdomen to identify and repair rectal injuries, drainage of presacral abscesses or fluid, and creation of a temporary sigmoid colostomy. This code captures care that is typically performed in an inpatient hospital operating room and reflects multidisciplinary surgical and postoperative management needs. Nationally, accurate coding for this procedure matters for clinical communication, quality measurement of trauma and colorectal surgery outcomes, and proper allocation of hospital resources.

Key payers commonly relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical site-of-service implications, common payer considerations, and benchmarking and policy topics related to inpatient surgical services. The publication outlines coding context, expected billing modifiers and payer coverage patterns where available, and highlights areas where documentation drives appropriate code assignment and reimbursement. It is intended for hospital coders, surgical clinicians, revenue cycle staff, and policy analysts seeking a concise, national-level summary of CPT code 45563 and its role in colorectal trauma and diversion procedures.

Data not available in the input: Associated taxonomies, specific ICD-10 diagnoses, related codes, payer-specific reimbursement rates, and service-line financial benchmarks.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 45563rectal injury repairsigmoid colostomyabdominal surgerycolorectal surgeryinpatient surgeryoperating room proceduressurgical exploration

Billing Code Overview

CPT code 45563 describes a surgical procedure that explores the low abdomen to identify and repair rectal injuries, drains presacral or presacral-area abscesses or fluid collections, and creates a temporary sigmoid colostomy on the abdominal surface to divert fecal stream and allow rectal healing.

Service type: Surgical procedure — exploratory laparotomy/abdominal exploration with rectal repair and diverting sigmoid colostomy
Typical site of service: Inpatient operating room or surgical suite, typically within a hospital setting where abdominal surgery and postoperative care are provided.

Clinical & Coding Specifications

Clinical Context

A 34-year-old male presents to the emergency department after a pelvic fracture from a motor vehicle collision with blood per rectum and pelvic sepsis signs. Imaging and examination raise high concern for an extraperitoneal rectal injury with presacral abscess. The surgical team performs an exploratory lower abdominal incision to inspect and repair the rectal injury, drains presacral purulence, and creates a diverting sigmoid colostomy to protect the repair and allow healing.

Clinical workflow: Patient stabilization in ED → trauma evaluation and pelvic imaging (CT) → broad-spectrum antibiotics and resuscitation → urgent surgical consent for examination under anesthesia → lower abdominal incision with transabdominal approach to expose rectum and presacral space → repair of rectal laceration if identified → presacral abscess drainage and irrigation → creation of end or loop sigmoid colostomy on abdominal wall → postoperative ICU or step-down monitoring for sepsis, wound care, ostomy management, and staged colostomy reversal planning if appropriate.

Typical site of service: Hospital inpatient operating room or emergency operating room for trauma surgery.

Service type: Major abdominal surgery (exploratory/repair) with creation of temporary diverting colostomy (sigmoid).

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for the procedure (document rationale).
`23`	Unusual anesthesia	Use when procedure is performed under general anesthesia due to unusual circumstances but no procedure performed under anesthesia alone.
`26`	Professional component	Use when reporting only the physician’s professional component for a service that has a split professional/technical component.
`52`	Reduced services	Use when the service performed is partially reduced or eliminated at the physician’s discretion.
`53`	Discontinued procedure	Use when procedure is started but discontinued due to extenuating circumstances or patient condition.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of a complex procedure.
`66`	Surgical team	Use when services are performed by a surgical team (multiple team members with shared responsibility).
`78`	Return to OR for related procedure during postoperative period	Use when patient returns to the operating room for a related procedure during the global period (e.g., reoperation for hemorrhage or dehiscence).
`79`	Unrelated procedure or service by same physician during postoperative period	Use when an unrelated procedure is performed during the global period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when a qualified assistant at surgery from these categories participates and must be reported per payer rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use if physician directs multiple concurrent anesthesia procedures related to the surgical episode.
`QX`	Qualified nonphysician anesthetist with medical direction by a physician	Use for CRNA services with physician direction if applicable.
`TC`	Technical component	Use when reporting only the facility/technical component of a service.

Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	Trauma and colorectal surgeons commonly perform this procedure.
2080P0206X	Colon & Rectal Surgery	Specialists in colorectal surgery manage rectal injuries and colostomy creation.
2086S0123X	Surgical Critical Care	Critical care surgeons direct complex trauma operative management and postoperative care.
207K00000X	Acute Care Surgery	Acute care/trauma surgeons providing emergency operative interventions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K63.2`	Fistula of intestine	Rectal or presacral fistula can necessitate diversion and drainage.
`K61.0`	Anal abscess	Perirectal or presacral abscess forcing operative drainage and possible diversion.
`S36.519A`	Injury of unspecified intraperitoneal organ, initial encounter	Trauma context requiring exploratory incision and repair of rectal injury.
`S36.529A`	Injury of unspecified retroperitoneal organ, initial encounter	Pelvic/retroperitoneal trauma associated with rectal injury and presacral infection.
`K62.5`	Hemorrhage of anus and rectum	Severe rectal bleeding from injury requiring operative exploration and diversion.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44140`	Colectomy, partial; with anastomosis	May be performed if colon injury or resection is required in addition to colostomy creation.
`44625`	Repair of rectal prolapse; transabdominal	Not typically identical but shares operative access and rectal repair principles when addressing rectal wall injuries.
`11042`	Debridement; skin and subcutaneous tissue	May be performed for necrotic wound or contaminated abdominal wall requiring debridement before or during colostomy creation.
`49020`	Drainage of perirectal abscess; transperineal or transrectal	Alternative approach for presacral or perirectal abscess drainage; may be performed if anatomy allows.
`76220`	Radiologic guidance for drainage procedures	Imaging guidance codes that may be used preoperatively or postoperatively for drainage or catheter placement in the presacral space.