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The procedure described by CPT® Code 45136 involves the excision of an ileoanal reservoir, which is a surgical intervention performed when complications arise from an existing ileoanal pouch. An ileoanal reservoir, commonly known as an intestinal pouch or J-pouch, is constructed from a segment of the small intestine to serve as a substitute for the rectum after the complete removal of the large intestine (colon) and the rectal lining. This procedure is typically indicated in cases where the ileoanal pouch has developed functional issues or has become infected, leading to conditions such as sepsis. The excision process requires careful surgical techniques, including the creation of a midline abdominal incision to access the abdominal cavity, the lysis of any intra-abdominal and small bowel adhesions, and the meticulous dissection of the ileoanal pouch from the surrounding tissues. The pouch is then detached from the anal mucosa through a perineal approach, allowing for its complete removal from the abdominal cavity. Following this, a second incision is made, often on the right side of the lower abdomen, to facilitate the creation of an ileostomy, where the distal segment of the ileum is brought through the abdominal wall and secured to the skin, allowing for the diversion of stool outside the body.
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The excision of an ileoanal reservoir with ileostomy is indicated in specific clinical scenarios where complications arise from the existing ileoanal pouch. These indications include:
The procedure for excising the ileoanal reservoir with ileostomy involves several critical steps, each performed with precision to ensure patient safety and optimal outcomes. The steps include:
Post-procedure care following the excision of the ileoanal reservoir with ileostomy involves monitoring the patient for any signs of complications, such as infection or bleeding. Patients may require pain management and will be educated on ileostomy care, including how to manage the stoma and the collection of stool. Recovery may involve a gradual return to normal activities, with specific dietary recommendations to support healing and adaptation to the new ileostomy. Follow-up appointments will be necessary to assess the patient's recovery and address any concerns related to the ileostomy.
| Short Descr | EXCISE ILEOANAL RESERVIOR | Medium Descr | EXC ILEOANAL RSVR W/ILEOSTOMY | Long Descr | Excision of ileoanal reservoir with ileostomy | 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). | 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. | 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. | 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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| 2002-01-01 | Added | First appearance in code book in 2002. |
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