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The procedure described by CPT® Code 45123 is a partial proctectomy performed via a perineal approach, primarily indicated for the treatment of malignant neoplasms located in the rectum. In this surgical intervention, the lower bowel undergoes cleansing through rectal irrigation to prepare for the operation. The technique involves making lateral incisions on both sides of the anus, which are then extended both anteriorly and posteriorly to facilitate access to the rectal area. A critical aspect of this procedure is the closure of the anus using a purse-string suture, which helps to secure the area post-excision. As the surgery progresses, the pudendal vessels are carefully clamped and ligated upon encountering them, ensuring minimal bleeding during the operation. The incision is then advanced posteriorly through the anococcygeal ligament and anteriorly, it is extended proximally behind the prostatic or vaginal fascia. Following this, the rectum is closed below the intended transection site with another purse-string suture, and the rectum is transected above the neoplasm. The levator muscles are divided to allow for the removal of the diseased portion of the colon through the perineal incision. Ultimately, the rectum is divided above the purse-string sutures, and the affected section is excised, with careful control of any bleeding before the incisions are closed. This detailed approach ensures that the malignant tissue is effectively removed while maintaining as much surrounding structure as possible.
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The procedure is indicated for the treatment of malignant neoplasms of the rectum. This condition may present with various symptoms, including rectal bleeding, changes in bowel habits, and abdominal pain, which necessitate surgical intervention to remove the cancerous tissue and prevent further complications.
The procedure involves several critical steps to ensure the effective removal of the malignant tissue while minimizing complications.
Post-procedure care involves monitoring for any signs of complications such as bleeding or infection at the surgical site. Patients may require pain management and should be advised on dietary modifications to facilitate recovery. Follow-up appointments are essential to assess healing and ensure that there are no signs of recurrence of the malignancy. The healthcare team will provide specific instructions regarding activity restrictions and wound care to promote optimal recovery.
| Short Descr | PARTIAL PROCTECTOMY | Medium Descr | PRCTECT PRTL W/O ANAST PRNL APPR | Long Descr | Proctectomy, partial, without anastomosis, perineal approach | 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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 |
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| 1995-01-01 | Added | First appearance in code book in 1995. |
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