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The procedure described by CPT® Code 45120 is known as a complete proctectomy, specifically performed for congenital megacolon, which is also referred to as Hirschsprung's disease. This condition is characterized by the absence of ganglion cells, a specialized type of nerve cell, in the rectum and potentially extending into varying lengths of the colon. The absence of these nerve cells results from a failure during fetal development, where the ganglion cells do not migrate along the bowel, leading to significant functional abnormalities. Patients with congenital megacolon may experience a range of symptoms, from complete bowel obstruction to severe constipation, necessitating surgical intervention. The surgical approach for this procedure involves both abdominal and perineal access. A midline incision is made in the abdomen to allow for exploration and identification of the affected bowel segments. The surgical technique includes the removal of the abnormal bowel segments, which are then replaced with segments of normal bowel that contain the necessary nerve cells. This is achieved by pulling down a healthy segment of bowel and connecting it to the anal mucosa, thereby restoring normal bowel function. The procedure may also be referred to by specific names such as the Swenson, Duhamel, or Soave operation, which are variations of the technique used to perform the anastomosis between the remaining bowel and the anal area. The goal of this surgery is to alleviate the symptoms associated with congenital megacolon and to improve the patient's quality of life by restoring normal bowel function.
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The procedure described by CPT® Code 45120 is indicated for patients diagnosed with congenital megacolon, also known as Hirschsprung's disease. This condition is characterized by the following:
The procedure for CPT® Code 45120 involves several critical steps, which are detailed as follows:
Post-procedure care for patients undergoing CPT® Code 45120 includes monitoring for any complications related to the surgery, such as infection or anastomotic leakage. Patients may require pain management and should be observed for signs of bowel function returning. Recovery may involve a gradual reintroduction of diet, starting with clear liquids and progressing as tolerated. Follow-up appointments are essential to assess healing and ensure that the anastomosis is functioning properly. Additional considerations may include education on bowel management and potential long-term effects of the surgery.
| Short Descr | REMOVAL OF RECTUM | Medium Descr | PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS | Long Descr | Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with pull-through procedure and anastomosis (eg, Swenson, Duhamel, or Soave type operation) | 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). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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 |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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