Accurate coding of complex rectal prolapse procedures is essential for accurate billing and compliance. Operative note misinterpretation matters Even minor errors in reading op notes can result in denials or down coding.
Report an advanced procedure under CPT Code 45135 with rectopexy and sigmoidectomy, if applicable, and levatorplasty.
Why this matters:
- It includes multiple surgical steps.
- It is prone to payer edits and denials.
- Coders should be cautious to distinguish it from 45130 and 45540.
1) What Is CPT Code 45135?
CPT: 45755 – Rectopexy, abdominal, with or without sigmoidectomy, with levatorplasty.
- Rectopexy – when the rectum is surgically fixed in place to not allow prolapse.
- Sigmoidectomy = removal of sigmoid colon (optional).
- Levatorplasty = tightening or repair of the levator ani muscles to support pelvic floor.
Clinical use:
Regarding rectal prolapse combined with a weak pelvic floor, surgeons also use this code for performing sigmoid resection.
2) When to Use CPT code 45135
Use CPT 45135 in these cases:
- Abdominal rectopexy associated with levatorplasty.
- Surgeons also perform sigmoidectomy (if indicated).
- Pelvic rehabilitation for serious rectal prolapse.
Do not use 45135 if:
- Rectopexy without levatorplasty → 45130 (with sigmoidectomy) or 45540 (without resection).
- Perineal rectopexy → use another CPT family.
3) Documentation Requirements
Billing Information The operative note needs to contain the following information in order for billing to be correct:
- Rectopexy performed (abdominal approach).
- Sigmoidectomy completed/not performed.
- Levatorplasty (method and reinforcement explained).
An indication of, for example, rectal prolapse, pelvic floor dys funktion and/or redundant sigmoid colon.
ICD-10 support, examples:
- K62.3 (Rectal prolapse)
- N81. 89 (Other specified female genital prolapse/pelvic floor weakness)
4) Reimbursement Insights
- RVUs: Greater than CPT 45130 – levatorplasty is part of the procedure.
- Medicare: when levatorplasty is medically necessary and well-documented.
- Private payers: Typically need preauthorization for complex prolapse surgeries.
Common denial reasons:
- Levatorplasty not noted on the OP report.
- The surgeon only did rectopexy + sigmoidectomy (> Should be 45130).
- Inappropriate modifier use for multiple abdominal cases.
5) Common Coding Mistakes
Avoid these pitfalls:
- Confounded with 45540 (rectopexy without resection).
- Missing documentation of levatorplasty.
- Billing levatorplasty as a separate procedure (cannot – this is inclusive to 45135).
6) Best Practices for CPT code 45135
Checklist for coders:
- Confirm levatorplasty is documented.
- Confirm abdominal (not perineal) approach.
- Make sure there is a note in the op report on whether sig was performed.
- Double-check with ICD-10 codes for rectal prolapse or pelvic floor dysfunction.
- Pre-bill chart review for compliance and payer edits.
Conclusion
The CPT code 45135 is distinct as it includes rectopexy (rectal suspension) with or without anastomosis and levatorplasty, and it should not be confused with CPT codes 45130 or 45540. Accurate use of Rectal Prolapse Surgery Billing Codes is essential for proper reimbursement. Without clear documentation of levatorplasty, charges may be denied or downcoded. Coders and surgeons, in collaboration with The Medicators, must prioritize detailed operative notes and conduct payer checks to ensure efficient reimbursement.
FAQs
Q1. What is included in CPT code 45135?
It consists of rectopexy, abdominal approach, and has or does not have sigmoidectomy associated with it with levatorplasty.
Q2. What is the difference between 45135 and 45130 and 45540?
- 45135 = rectopexy with or without sigmoidectomy and levatorplasty.
- 45130 = rectopexy and sigmoidectomy (without levatorplasty).
- 45540 = rectopexy,abdominal no resection.
Q3. Do you automatically charge a sigmoidectomy with 45135?
No, sigmoidectomy is already added if it is performed with rectopexy+levatorplasty.
Q4. What is the ICD-10 for CPT 45135-Sliding hernia without obstruction or gangrene, with/without gangrene to rectal prolapse?
Common codes: K62. 3 (rectal prolapse) and N81. 89 (pelvic floor weakness).
Q5. What is the reason for recurring denials of CPT 45135 from payers?
The most common reasons are:
- Missing levatorplasty documentation.
- Billing with the incorrect CPT (45130 rather than 45135).
- Modifier errors when billed in conjunction with other abdominal procedures.
