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The CPT® Code 45121 refers to a complete proctectomy performed through both abdominal and perineal approaches, specifically indicated for congenital megacolon, which is also known as Hirschsprung's disease. This condition is characterized by the absence of ganglion cells, a specialized type of nerve cell, in the rectum and varying lengths of the colon. The absence of these cells results from a failure during fetal development, where the ganglion cells do not migrate along the bowel, leading to abnormal intestinal function. Patients with congenital megacolon may experience symptoms ranging from complete bowel obstruction to severe constipation, necessitating surgical intervention. The procedure involves the removal of the affected bowel segments and the replacement of these segments with healthy bowel that contains normal nerve cells. This is achieved by pulling down a segment of normal bowel and connecting it to the anal mucosa. The operation may also be referred to as a Swenson, Duhamel, or Soave operation, depending on the specific surgical technique employed. In this procedure, multiple biopsies of the bowel are obtained to identify the location of normal nerve tissue before the resection of the rectum and part or all of the colon is performed. This comprehensive approach ensures that the abnormal bowel is effectively removed while preserving as much functional bowel as possible.
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The procedure described by CPT® Code 45121 is indicated for the treatment of congenital megacolon, also known as Hirschsprung's disease. This condition is characterized by the following:
The procedure for CPT® Code 45121 involves several critical steps, which are detailed as follows:
Post-procedure care for patients undergoing CPT® Code 45121 includes monitoring for complications such as infection, bleeding, or anastomotic leakage. Patients are typically observed in a postoperative setting for signs of recovery, including bowel function resumption. Pain management is provided as needed, and dietary modifications may be implemented to facilitate healing. Follow-up appointments are essential to assess the surgical site and overall recovery, as well as to ensure that normal bowel function is restored. Additional imaging or diagnostic tests may be required to evaluate the success of the procedure and the presence of any complications.
| Short Descr | REMOVAL OF RECTUM AND COLON | Medium Descr | PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS | Long Descr | Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with subtotal or total colectomy, with multiple biopsies | 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 |
| 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). | 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 |
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| Pre-1990 | Added | Code added. |
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