How To Use CPT Code 45500

CPT 45500 describes a proctoplasty procedure used to release stenosis in the anorectal area. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 45500?

CPT 45500 is a code used to describe a proctoplasty procedure. This procedure is performed to release stenosis in the anorectal area by incising scar tissue and repairing it with nearby tissue flaps.

2. Official Description

The official description of CPT code 45500 is: ‘Proctoplasty; for stenosis.’

3. Procedure

1. During the proctoplasty procedure, the provider makes a longitudinal incision in the scar tissue of the anorectal area.
2. The scar tissue may be completely removed until an area of normal mucosa is exposed.
3. The provider then creates flaps with the surrounding perianal skin and brings them close to the normal mucosa at the edges of the incised or excised scar.
4. The wound is repaired, allowing for the release of stenosis in the anorectal area.

4. Qualifying circumstances

Proctoplasty with CPT code 45500 is performed for patients with stenosis in the anorectal area. Stenosis refers to the narrowing of a vessel or structure. The procedure is appropriate when scar tissue is causing the stenosis, and the provider needs to release it to restore normal function.

5. When to use CPT code 45500

CPT code 45500 should be used when a proctoplasty procedure is performed to release stenosis in the anorectal area. It is important to ensure that the procedure meets the specific criteria outlined in the official description.

6. Documentation requirements

To support a claim for CPT code 45500, the provider must document the following information:

• Patient’s diagnosis indicating the presence of stenosis in the anorectal area
• Details of the procedure performed, including the incision of scar tissue and repair with tissue flaps
• Date of the procedure
• Any additional relevant information or findings during the procedure
• Signature of the provider performing the proctoplasty

7. Billing guidelines

When billing for CPT code 45500, ensure that the procedure meets the criteria described in the official description. It is important to follow the specific guidelines provided by the payer and use the appropriate modifiers if necessary. Report CPT code 45500 separately and do not report it with other codes unless specifically instructed by the payer.

8. Historical information

CPT code 45500 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with anorectal stenosis undergoes a proctoplasty procedure to release the scar tissue and restore normal function.
2. A provider performs a proctoplasty on a patient with stenosis caused by previous surgery in the anorectal area.
3. A proctoplasty is performed on a patient with anorectal stenosis due to inflammatory bowel disease.
4. A patient with scar tissue causing anorectal stenosis undergoes a proctoplasty procedure to alleviate symptoms and improve quality of life.
5. A provider performs a proctoplasty on a patient with anorectal stenosis caused by trauma or injury.
6. A proctoplasty is performed on a patient with anorectal stenosis resulting from radiation therapy.
7. A patient with anorectal stenosis due to a congenital condition undergoes a proctoplasty procedure to improve bowel function.
8. A provider performs a proctoplasty on a patient with anorectal stenosis caused by a chronic inflammatory condition.
9. A proctoplasty is performed on a patient with anorectal stenosis resulting from a previous infection or abscess.
10. A patient with anorectal stenosis undergoes a proctoplasty procedure to relieve symptoms such as pain, discomfort, and difficulty with bowel movements.