Precise coding among colorectal surgeons is essential to secure payment and avoid denials. Even relatively minor holes in documentation can spell trouble.
CPT Code 45400 The code for sigmoidectomy, or resectioning of the sigmoid colon.
It is a frequent surgery for the following:
- Colorectal cancer.
- Diverticulitis.
- Bowel obstruction.
This code can be misunderstood by coders and appropriate documentation must accompany the claim, payer edit is also a problem.
1) What Is CPT Code 45400?
CPT Code Description: So the official description of your procedure would be “Sigmoidectomy (removal of sigmoid colon).”
A sigmoidectomy is the surgical removal of all or part of the sigmoid colon, which is situated in the last section of the large intestine.
Indications for this procedure include:
- Colorectal cancer.
- Diverticular disease.
- Chronic constipation or obstruction.
- Sigmoid volvulus (torsion) 1.
2) When to Use CPT code 45400
Use 45400 when:
- The surgeon takes out the sigmoid colon of the patient.
- The operation is performed using an open abdominal technique.
Do not use 45400 if:
- The operation is performed laparoscopically→ use 44204 or other laparoscopic colectomy codes.
- A colectomy is required (list separately in addition to the code for the primary procedure) – use family 44140–44160.
- Sigmoidectomy with rectopexy → 45130 or 45135.
3) Documentation Requirements
Coders need to verify that the op note is as follows:
- Operation: explicit determination to the effect that a sigmoidectomy was carried out.
- Approach: abdominal/open.
- Indication: diverticulitis, tumor, or obstruction.
- Resection range: the whole or part of the sigmoid colon removed.
- Anastomosis characteristics: whether bowel was resected.
- Pathology findings: confirming medical necessity.
4) Reimbursement Insights
- RVUs: Sigmoidectomy has less RVUs as extended colectomy codes, but pays well.
- Medicare: To the extent that medical necessity is shown.
- Private payors: Prior authorization may be required, particularly for non-emergent situations.
Common denial reasons include:
- Operative note not specifying sigmoidectomy.
- 45400 when the laparoscopic approach was done.
5) Common Coding Mistakes
Avoid these errors:
- Using 45400 for laparoscopic cases.
- Mistaking it for 44140 (partial colectomy).
- Billing more than one colectomy code when only one is appropriate.
- Failure to link the proper ICD-10 code (including diverticulitis or cancer).
6) Best Practices for CPT code 45400
Checklist for coders:
- Make sure open sigmoidectomy is noted.
- Check that ICD-10 codes justify medical necessity.
- Look for payer-specific bundling rules.
- Specify whether sigmoidectomy was an isolated (only) procedure (as rectopexy).
- Promote communication between providers and coders; encourage audits.
Conclusion
The specific code for open sigmoidectomy is CPT code 45400. Proper coding, including the use of accurate Rectal Prolapse Surgery Billing Codes, ensures fewer denials and greater reimbursement.
Always remember to:
- Distinguish from laparoscopic or extended colectomy codes.
- Verify the details of operative procedure on the surgeon’s note.
- Match the procedure in plan with its appropriate diagnosis code.
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FAQs
Q1. What is HCPCS code 45400 for colorectal surgery?
It is employed when the surgeon uses an open approach and respects the sigmoid.
Q2. What is the difference between CPT code 45400 versus 44140 or 44204?
- 45400 = open sigmoidectomy.
- 44140 = open partial colectomy.
- 44204 = laparoscopic colectomy.
Q3. What is my insurance paying for CPT 45400?
Examples include C18. 7 (malignant neoplasm of sigmoid colon) and K57. 32 (diverticulitis of colon without perforation or abscess).
Q4. Is CPT 45400 covered by Medicare for diverticulitis or cancer?
Yes, with medical necessity documented.
Q5. Why are CPT 45400 denials so common among payers?
Some common causes of denial are lack of documentation, incorrect usage of the laparoscopic codes or forgetting to include the appropriate ICD-10 diagnosis.
