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The procedure described by CPT® Code 44128 involves an enterectomy, which is a surgical resection of the small intestine specifically performed for congenital atresia. Congenital atresia is a birth defect characterized by a complete obstruction of the small intestine, leading to the dilation of the intestinal segment that is proximal to the obstruction site. This condition can also result in the dilation of the stomach and hypertrophy of the pylorus, which may become distended. During the procedure, the surgeon makes a midline incision to access the abdominal cavity, allowing for the inspection of the abdominal organs, including the liver and gallbladder. The surgeon identifies the dilated section of the small intestine, carefully dissects it from surrounding tissues, and manages blood vessels by clamping and ligating them as necessary. The affected segment of the small intestine is then excised, and the remaining proximal and distal segments are reconnected through anastomosis. This connection may involve creating a diamond-shaped anastomosis to accommodate the differences in the size and shape of the intestinal segments. CPT® Code 44128 is specifically used to report each additional resection and anastomosis beyond the primary procedure, which is coded separately using CPT® Codes 44126 or 44127, depending on the specific technique employed for the anastomosis.
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The procedure is indicated for patients diagnosed with congenital atresia of the small intestine, which is characterized by a complete obstruction of the intestinal lumen. This condition can lead to significant complications, including the dilation of the proximal segment of the intestine, which may cause discomfort and further gastrointestinal issues. Symptoms may include abdominal distension, vomiting, and failure to thrive in infants. Surgical intervention is necessary to remove the obstructed segment and restore normal intestinal continuity.
The procedure involves several critical steps to ensure the successful resection and anastomosis of the small intestine. First, the surgeon makes a midline incision in the abdominal wall to gain access to the abdominal cavity. This incision allows for the exposure and inspection of the abdominal contents, including vital organs such as the liver and gallbladder. Once the abdominal cavity is accessed, the surgeon identifies the dilated section of the small intestine that is proximal to the site of obstruction. This segment is carefully dissected free from surrounding tissues to minimize damage to adjacent structures. Blood vessels supplying the affected segment are clamped and ligated to control bleeding during the procedure. The surgeon then divides the small intestine using either staples or noncrushing clamps, ensuring a clean cut. The dilated segment is excised, and the remaining proximal and distal segments of the intestine are prepared for anastomosis. Given that the proximal segment is typically dilated and the distal segment is thin-walled and flattened, a diamond-shaped anastomosis is often created. This technique involves making a longitudinal incision in the distal segment and a transverse incision in the inferior aspect of the dilated proximal segment. The two segments are then sutured together to restore intestinal continuity. It is important to note that CPT® Code 44128 is used to report each additional resection and anastomosis performed during the procedure, while the primary anastomosis is reported using CPT® Codes 44126 or 44127, depending on the specific technique utilized.
After the procedure, patients are typically monitored for any signs of complications, such as infection or leakage at the anastomosis site. Post-operative care may include pain management, intravenous fluids, and gradual reintroduction of oral intake as tolerated. The expected recovery period can vary depending on the individual patient's condition and the extent of the surgery performed. Follow-up appointments are essential to assess healing and ensure that the intestinal function is restored. Additional considerations may include dietary modifications and monitoring for any long-term complications associated with congenital atresia and surgical intervention.
| Short Descr | ENTERECTOMY CONG ADD-ON | Medium Descr | ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS | Long Descr | Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; each additional resection and anastomosis (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 2 | CCS Clinical Classification | 75 - Small bowel resection |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 44126 | Modifier 63 Exempt MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; without tapering | 44127 | Modifier 63 Exempt MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; with tapering |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2002-01-01 | Added | First appearance in code book in 2002. |
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