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Proctopexy with sigmoid resection, abdominal approach, is a surgical procedure aimed at addressing rectal prolapse, a condition where the rectum protrudes through the anus. This procedure is particularly indicated when the prolapse is significant and requires not only the fixation of the rectum to the sacrum but also the removal of a portion of the sigmoid colon and upper rectum to facilitate proper anatomical alignment and function. The surgery involves a midline abdominal incision, through which the sigmoid colon and rectum are carefully dissected from the surrounding presacral fascia. This dissection allows for the mobilization of the rectum, enabling the surgeon to access the presacral space and reduce the prolapse effectively. The procedure is characterized by the interruption of the vascular supply to the affected segment, which is achieved by ligating and dividing the inferior mesenteric artery or the individual sigmoid arteries. Following the resection of the sigmoid colon, the remaining segments are sutured together in a process known as anastomosis, ensuring continuity of the bowel. This comprehensive approach not only addresses the prolapse but also aims to restore normal bowel function and prevent recurrence of the condition.
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The procedure is indicated for the treatment of rectal prolapse, which may present with various symptoms and conditions that necessitate surgical intervention. The following are the explicitly provided indications for performing this procedure:
The procedure involves several critical steps to ensure effective treatment of rectal prolapse. Each step is detailed as follows:
Post-procedure care is essential for ensuring proper recovery and minimizing complications. After the surgery, patients are typically monitored for any signs of complications such as infection or bleeding. Pain management is provided as needed, and patients may be advised on dietary modifications to facilitate bowel movements. Follow-up appointments are crucial to assess the surgical site and ensure that the rectum remains properly positioned. Patients are generally encouraged to gradually resume normal activities, but specific restrictions may be advised based on individual recovery progress. It is important for patients to report any unusual symptoms, such as increased pain or changes in bowel habits, to their healthcare provider promptly.
| Short Descr | REPAIR RECTUM/REMOVE SIGMOID | Medium Descr | PROCTOPEXY W/SIGMOID RESCJ ABDL APPR | Long Descr | Proctopexy (eg, for prolapse); with sigmoid resection, abdominal 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. | 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). | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2006-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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