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The procedure described by CPT® Code 45112 refers to a proctectomy that is performed as a combined abdominoperineal pull-through procedure, specifically involving a colo-anal anastomosis. This surgical intervention is typically indicated for patients with conditions affecting the rectum and lower gastrointestinal tract, necessitating the removal of the rectum while preserving the anal mucosa. The term 'proctectomy' denotes the surgical excision of the rectum, and in this case, it is performed through both abdominal and perineal approaches. The procedure involves a midline incision in the abdomen, allowing for exploration and identification of the proximal transection site, which may include a segment of the sigmoid colon. The mobilization of the sigmoid colon and rectum is crucial for the subsequent steps, which include the creation of an anastomosis between the remaining colon and the anal mucosa. This technique aims to restore bowel continuity and function after the removal of the diseased rectal tissue, ensuring that the patient can maintain normal defecation postoperatively. The careful dissection and removal of the rectum and surrounding mesentery are performed to minimize complications and facilitate a successful anastomosis, which is a critical aspect of this complex surgical procedure.
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The combined abdominoperineal pull-through procedure, as described by CPT® Code 45112, is indicated for various conditions affecting the rectum and lower gastrointestinal tract. These indications may include:
The procedure involves several critical steps to ensure successful completion and patient safety. These steps include:
Post-procedure care following a combined abdominoperineal pull-through procedure includes monitoring for complications such as infection, anastomotic leakage, and bowel obstruction. Patients are typically advised to follow a specific diet and may require pain management. Recovery time can vary, but patients are generally expected to stay in the hospital for several days for observation and management of any postoperative issues. Follow-up appointments are essential to assess healing and ensure that the anastomosis is functioning properly.
| Short Descr | REMOVAL OF RECTUM | Medium Descr | PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX | Long Descr | Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 78 - Colorectal resection |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| Pre-1990 | Added | Code added. |
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