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Official Description

Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 44130 refers to an enteroenterostomy, which is a surgical technique used to create an anastomosis, or connection, between two segments of the intestine. This procedure may be performed with or without the creation of a cutaneous enterostomy, which is an opening made in the abdominal wall to allow for the passage of intestinal contents. The primary purpose of an enteroenterostomy is to restore continuity of the intestinal tract after a segment has been resected or bypassed due to various medical conditions. The surgery typically involves a midline incision in the abdomen to access the intestines, followed by careful dissection to free the affected segments from surrounding tissues. The surgeon identifies the previously divided segments of the small intestine, prepares them for anastomosis by incising at designated sites, and then sutures the segments together using various configurations such as end-to-end, end-to-side, or side-to-side. If a cutaneous enterostomy is indicated, a separate incision is made to create an opening in the abdominal wall, allowing a segment of the small bowel to be exteriorized and secured to the skin. This procedure is critical in managing intestinal continuity and function, particularly in patients who have undergone resections due to disease or injury.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The enteroenterostomy procedure, as described by CPT® Code 44130, is indicated for various clinical scenarios where there is a need to reconnect segments of the small intestine. The following conditions may warrant this surgical intervention:

  • Resection of Intestinal Segments - This procedure is often performed following the surgical removal of a portion of the small intestine due to conditions such as tumors, inflammatory bowel disease, or trauma.
  • Bypass of Obstructed Intestine - An enteroenterostomy may be indicated to bypass an obstructed segment of the intestine, allowing for the restoration of intestinal continuity and function.
  • Management of Complications - The procedure can also be necessary to address complications arising from previous surgeries, such as strictures or fistulas that disrupt normal intestinal flow.

2. Procedure

The enteroenterostomy procedure involves several critical steps to ensure successful anastomosis of the intestine. The following outlines the procedural steps involved:

  • Step 1: Abdominal Incision - The surgeon begins by making a midline incision in the abdominal wall to gain access to the abdominal cavity. This incision allows for the exposure of the intestines and surrounding organs.
  • Step 2: Lysis of Adhesions - Once the abdominal cavity is accessed, any adhesions that may be present are lysed using both blunt and sharp dissection techniques. This step is crucial for freeing the intestines from surrounding tissues and ensuring proper visibility and access.
  • Step 3: Inspection of Abdominal Contents - The surgeon inspects the abdominal contents, including the liver, gallbladder, and other organs, to assess their condition and ensure there are no additional complications that need to be addressed.
  • Step 4: Identification of Intestinal Segments - The previously divided segments of the small intestine are identified and carefully dissected free from surrounding tissue to prepare them for anastomosis.
  • Step 5: Vascular Control - Blood vessels supplying the intestinal segments are clamped and ligated with sutures as necessary to prevent bleeding during the anastomosis.
  • Step 6: Anastomosis of Intestinal Segments - The identified segments of the intestine are incised at the planned anastomosis sites. The proximal and distal segments are then sutured together, creating the anastomosis. Various configurations, such as end-to-end, end-to-side, or side-to-side, may be utilized based on the surgical plan.
  • Step 7: Creation of Cutaneous Enterostomy (if indicated) - If a cutaneous enterostomy is required, a small skin incision is made over the planned enterostomy site. The incision is carried down through the subcutaneous tissue, and fat is excised to expose the anterior rectus fascia. The rectus muscle fibers are separated using blunt dissection, and the peritoneum is entered. An opening of sufficient diameter is created for the stoma, and the segment of small bowel to be exteriorized is brought through the abdominal wall and sutured to the skin.
  • Step 8: Closure of the Abdomen - After the anastomosis is completed, the abdomen may be closed in layers, ensuring that all tissues are properly aligned and secured.

3. Post-Procedure

Following the enteroenterostomy procedure, patients typically require careful monitoring and post-operative care. Expected recovery may involve a hospital stay where the surgical site is observed for signs of infection or complications. Patients may be placed on a specific diet to allow the intestines to heal properly, gradually transitioning from intravenous fluids to oral intake as tolerated. Pain management is also an essential aspect of post-operative care. Additionally, the surgical team will provide instructions regarding activity restrictions and follow-up appointments to monitor the healing process and ensure the success of the anastomosis.

Short Descr BOWEL TO BOWEL FUSION
Medium Descr ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX
Long Descr Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard 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 73 - Ileostomy and other enterostomy

This is a primary code that can be used with these additional add-on codes.

96547 Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure)
96548 Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure)
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
GC This service has been performed in part by a resident under the direction of a teaching physician
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).
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AG Primary physician
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
RT Right side (used to identify procedures performed on the right side of the body)
XP Separate practitioner, a service that is distinct because it was performed by a different practitioner
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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