Medical Billing · Nationwide
Colorectal Surgery & Complex Pelvic Exenteration Medical Billing Services
Total mesorectal excision (TME), low anterior resection (LAR) with coloanal anastomosis, multivisceral pelvic exenteration, diverting loop ileostomy creation and reversal, and sacrectomy co-surgery.
Aethera Healthcare Solutions provides full-service medical billing and revenue cycle management to colorectal surgeons, surgical oncologists, pelvic reconstructive surgeons, and lower GI surgical groups across the United States. We handle coding, claims, payment posting, denial management, and A/R follow-up end to end — so your team can stay focused on patient care while your revenue cycle runs cleanly.
Typical colorectal surgery & complex pelvic exenteration CPT range we work: 45110, 45119, 45126, 45136, 44140, 44145, 44204, 44320, 44625, 49010, 50650, 99223.
Why colorectal surgery & complex pelvic exenteration billing leaks revenue
Pelvic exenteration multi-surgeon unbundling denials: Payers rejecting co-surgeon or team surgery billing (Modifier 62/66) across colorectal, urologic, and gynecologic teams during en bloc multivisceral pelvic resections (CPT 45126)
Diverting stoma creation bundled into resection: Inappropriate bundling of protective loop ileostomy (44320/44145) into low anterior resection (45119) despite distinct laparoscopic or open mobilization documentation
Ureteral stent / vascular isolation disallowance: Payer denial of prophylactic indocyanine green (ICG) perfusion angiography (CPT +15777 / 0596T) or cystoscopic stent placement prior to deep pelvic dissection
Laparoscopic vs open conversion disputes: Downcoding of robotic/laparoscopic LAR conversions (CPT 44204 converted to 44145) with failure to reimburse complex open pelvic mobilization time carve-outs
How Aethera fixes it
Specialty-trained coders (CPC/CCS) code to the documentation
First-pass claim scrubbing against payer and NCCI edits
Proactive denial prevention and 72-hour denial work
Relentless A/R follow-up to drive days-in-A/R down
Eligibility and prior-auth verification before service
Transparent, real-time reporting in the provider portal
Free tools for your billing team
Use these any time — no login required.
Colorectal Surgery & Complex Pelvic Exenteration billing FAQ
How should pelvic exenteration (CPT 45126) with bladder and rectal resection be coded across multiple surgical specialists?
CPT 45126 (pelvic exenteration for colorectal malignancy with proctectomy, cystectomy, hysterectomy, and pelvic lymphadenectomy) allows co-surgery when distinct specialists perform separate components (e.g. colorectal surgeon performing proctectomy and bowel reconstruction; urologic oncologist performing cystectomy and urinary diversion). Both surgeons must dictate separate operative notes detailing their individual surgical involvement and append Modifier 62. If an additional gynecologic surgeon performs the vaginectomy/hysterectomy portion, Modifier 66 (team surgery) with comprehensive operative protocol documentation is required.
Can a diverting loop ileostomy (CPT 44320) be separately billed with a low anterior resection (CPT 45110)?
CPT 45110 describes proctectomy with pull-through and coloanal anastomosis, while CPT 45119 includes creation of a colonic J-pouch reservoir. When a diverting loop ileostomy is placed to protect a high-risk ultra-low anastomosis, CPT 44145 (partial colectomy with colostomy) or 44320 (colostomy/ileostomy) is subject to NCCI edit rules. If performed through a separate abdominal incision or clearly dictated as a non-integral protective bypass, documentation must specify medical necessity (e.g. prior pelvic radiation, ultra-low anastomotic height <3cm from anal verge) to defend modifier XE/59.