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The procedure described by CPT® Code 45119 is a proctectomy that involves a combined abdominoperineal pull-through technique, which is specifically designed for patients requiring surgical intervention for conditions affecting the rectum and colon. This complex surgical procedure includes the creation of a colonic reservoir, often referred to as a J-pouch, which serves as a new storage area for stool after the rectum has been removed. The procedure is typically indicated for patients with certain colorectal diseases, such as familial adenomatous polyposis or rectal cancer, where the rectum is compromised and needs to be excised. The operation is performed through a midline abdominal incision, allowing the surgeon to access the abdominal cavity and the colon effectively. The mobilization of the colon is a critical step, as it prepares the segment of the colon that will be fashioned into the reservoir. The meticulous dissection and removal of the rectum, while preserving the anal mucosa, is essential to ensure proper function and healing post-surgery. Additionally, if deemed necessary, a diverting enterostomy may be created to divert stool away from the surgical site, facilitating recovery and reducing the risk of complications. This procedure requires a high level of surgical skill and is typically performed in a hospital setting, with careful postoperative management to ensure optimal recovery and function of the newly created colonic reservoir.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 45119 is indicated for specific conditions affecting the rectum and colon. These indications may include:
The procedure involves several critical steps, each essential for the successful completion of the surgery:
Post-procedure care is critical for recovery following a proctectomy with colonic reservoir creation. Patients are typically monitored for complications such as infection, bleeding, or issues related to the anastomosis. Pain management is provided, and patients may require nutritional support as they adjust to changes in bowel function. Follow-up appointments are essential to assess healing and the function of the colonic reservoir. If a diverting enterostomy was performed, education on stoma care and management is provided to ensure patient comfort and effective waste management. The recovery process may vary, and patients are advised to follow their healthcare provider's instructions closely to promote optimal healing and recovery.
| Short Descr | REMOVE RECTUM W/RESERVOIR | Medium Descr | PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM | Long Descr | Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy when performed | 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. | 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). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2006-01-01 | Changed | Code description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |
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