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The CPT® Code 45900 refers to the procedure for the reduction of procidentia, which is a medical condition characterized by the complete prolapse of the rectum through the anus. This condition can lead to significant discomfort and complications if not addressed. The procedure is performed under anesthesia, ensuring that the patient is comfortable and pain-free during the intervention. During the reduction, the physician employs manual manipulation techniques to reposition the rectum back into its normal anatomical position. This is considered a separate procedure, meaning it is distinct from other surgical interventions that may be performed concurrently. Following the reduction, the physician secures the buttocks together with tape to minimize the risk of the rectum prolapsing again. It is important to note that this reduction is typically a temporary solution; most patients will eventually require a more definitive surgical procedure to fixate the rectum and prevent future episodes of prolapse.
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The procedure coded as CPT® 45900 is indicated for patients experiencing procidentia, which is the complete prolapse of the rectum through the anus. This condition may present with various symptoms, including discomfort, pain, and potential complications related to the prolapse. The reduction of procidentia is performed as a separate procedure to alleviate these symptoms and restore the rectum to its normal position.
The procedure for the reduction of procidentia involves several key steps that are performed under anesthesia to ensure patient comfort. First, the patient is placed under appropriate anesthesia, which may be general or regional, depending on the clinical scenario and physician preference. Following the induction of anesthesia, the physician assesses the extent of the prolapse and prepares for manual manipulation. The physician then carefully and gently manipulates the rectum back through the anus, guiding it into its normal anatomical position. This step requires skill and precision to avoid causing additional trauma to the surrounding tissues. Once the rectum is successfully repositioned, the physician secures the buttocks together using tape. This is a critical step, as it helps to prevent the rectum from prolapsing again immediately after the reduction. It is important to note that while this procedure can provide immediate relief, it is often a temporary measure, and most patients will require further surgical intervention to achieve a more permanent solution.
After the reduction of procidentia, patients are typically monitored for any immediate complications related to the procedure. The tape securing the buttocks may remain in place for a short period to help maintain the rectum's position. Patients are advised on post-procedure care, which may include instructions on activity restrictions and signs of complications to watch for, such as increased pain, bleeding, or signs of infection. It is essential for patients to follow up with their healthcare provider for further evaluation and to discuss the need for definitive surgical fixation of the rectum to prevent recurrence of the prolapse.
| Short Descr | REDUCTION OF RECTAL PROLAPSE | Medium Descr | RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE | Long Descr | Reduction of procidentia (separate procedure) under anesthesia | Status Code | Active Code | Global Days | 010 - Minor Procedure | 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 96 - Other OR lower GI therapeutic procedures |
| 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. | 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.) | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | E1 | Upper left, eyelid | E3 | Upper right, eyelid | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| Pre-1990 | Added | Code added. |
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