Basics of CPT code 45171, 45172 & 0184T

TEMS (transanal endoscopic microsurgery) is used to treat a variety of anal and rectal conditions but most commonly it is used to remove large polyps and small cancers. This procedure provides a better approach than traditional per anal operations and in many cases removes the need for major abdominal surgery on the rectum. CPT code 45171, 45172 & 0184T are use for reporting these exams.

Indications

Benign neoplasm of rectum
Benign carcinoid tumor of the rectum
Malignant carcinoid tumor of the rectum
Malignant neoplasm of overlapping sites of rectum, anus and anal canal
Malignant neoplasm of rectum

Description of CPT code 45171, 45172 & 0184T

The physician removes a rectal tumor through a transanal approach. The physician explores the anal canal and exposes the tumor. Report 45171 for a partial thickness excision (one that excludes the muscularis propria) and 45172 for a full thickness excision (including the muscularis propria). The defect in the rectum is closed with sutures.

For coding 0184T,the physician excises a rectal tumor using the transanal endoscopic microsurgical (TEMS) approach. Following administration of appropriate anesthesia, the patient is placed in a lithotomy position. Dilation of the rectum is achieved and maintained with constant-flow carbon dioxide insufflation. Using specially designed instruments inserted via a resectoscope, full-thickness excision (including the muscularis propria) of the tumor is achieved. Dissection and suturing are performed within the rectal cavity

45171                   Excision of rectal tumor, transanal approach; not including muscularis propria (i.e., partial thickness)
45172                           including muscularis propria (i.e., full thickness)
0184T                Excision of rectal tumor, transanal endoscopic microsurgical approach (i.e., TEMS), including muscularis propria (i.e.,full thickness)

EXCLUDES:
Excludes Transanal destruction rectal tumor (45190)
Excludes Transanal endoscopic microsurgical tumor excision (TEMS) (0184T)

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