Appropriate coding of colorectal surgery is vital to reimbursement and compliance. Complex actions sometimes require multiple steps — with things missing, which can lead to denials.
CPT code 45130 description: Rectopexy (rectal suspension) combined with sigmoidectomy (colon resection, usually used for Hegar type III rectocele)
This code matters because:
- It reflects a complex surgery.
- The reimbursement is better than that for single procedures.
- It is frequently miscoded as a result, which delays or denies payment.
1) What Is CPT Code 45130?
CPT Descriptor: Rectopexy, abdominal approach including simultaneous sigmoid resection.
- Sigmoidectomy = removal of the sigmoid colon surgically.
- Rectopexy = surgery to attach the rectum to something (commonly done for prevention of prolapse).
The Following are Some of the Common Reasons This Surgery Is Done for:
- Rectal prolapse.
- Severe constipation or obstructed defecation.
- Prolapse and sigmoid colon disease.
2) When to Use CPT code 45130
CPT 45130 should be reported when:
- Abdominal rectopexy and sigmoid resection are carried out in a single procedure.
- The patient has rectal prolapse associated with a redundant sigmoid colon.
Do not use 45130 when:
- When only a rectopexy is performed → can use 45540 (Rectopexy, abdominal).
- It is only sigmoidectomy → 44140 (sigmoidectomy only).
3) Documentation Requirements
The operative report must include:
- Presentation (e.g., rectal prolapse, a stool-containing sigmoid colon, obstruction).
- Operation confirming the sigmoidectomy and rectopexy.
- Approach (abdominal).
- Resection range and fixation modality.
- Anastomosis details if performed.
- ICD-10 support, such as:
- K62.3 (Rectal prolapse)
- K63. 89 (Other disorders of intestine)
4) Reimbursement Insights
- RVUs: Likely more than for rectopexy or sigmoidectomy alone as both procedures have been performed.
- Medicare: Pays if medical necessity is demonstrated (i.e., prolapse + redundant sigmoid).
- Private payers: Prolapse surgeries may need prior authorization.
Common denial reasons:
- Missing documentation of rectopexy.
- The report mentions sigmoidectomy only (changed to 44140).
5) Common Coding Mistakes
Watch out for these errors:
- Misplacing 45130 for 45540 (rectopexy alone).
- Mistaking it with 44140 (sigmoidectomy alone).
- No recording for fixation step → denial or recoding.
- Not relating the prolapse diagnosis to the surgery.
6) Best Practices for CPT code 45130
Use this quick checklist:
- Check that both operations (sigmoidectomy + rectopexy) have been written.
- Expel the abdominal (not perineal) approach.
- Tests must be supported by a diagnosis of medical necessity.
- Add appropriate modifiers If more procedures are performed.
Conclusion
CPT Code 45130 is used for combined rectopexy with sigmoidectomy and should not be confused with rectopexy alone (45540) or sigmoidectomy (44140). When handling Rectal Prolapse Surgery Billing Codes, documentation and coding must be precise to avoid denials. Always ensure operative notes clearly specify both resection and fixation, and confirm payer-specific rules before submission. For expert guidance in accurate reporting and compliance, The Medicators provide specialized support tailored to your billing needs.
FAQs
Q1. What is CPT Code code 45130 for?
It is employed in an abdominal rectopexy with resection of sigmoid.
Q2. What is the difference between 45130, 45540 and 44140?
- 45130 = rectopexy with sigmoidectomy.
- 45540 = rectopexy only.
- 44140 = sigmoidectomy only.
Q3. Which diagnoses allow you to bill CPT code 45130?
Typical ICD-10 codes include K62. 3 (rectal prolapse) and K63. 89 (diseases of intestine, other specified).
Q4. Is CPT 45130 pre auth under Medicare?
Usually, no. But certain private payers may require authorization for prolapse surgeries.
Q5. Why are CPT 45130 claims often denied?
Incomplete documentation of rectopexy or lack of associated diagnosis are the common reasons for denials.
