© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 44151 refers to a total abdominal colectomy performed without proctectomy, accompanied by the creation of a continent ileostomy. This surgical procedure involves a comprehensive approach to remove the entire colon while preserving the rectum. The operation begins with a midline abdominal incision, allowing the surgeon to inspect the abdominal cavity thoroughly. The entire colon is mobilized through the division of lateral peritoneal attachments and the separation of the omentum from the transverse colon. The mesentery, which is the tissue that supports the colon, is carefully divided starting from the left colon and moving proximally. The bowel is then transected at the rectosigmoid junction distally and just above the ileocecal valve proximally, leading to the complete removal of the diseased colon. In this procedure, a continent ileostomy is created, which is a specialized type of ileostomy that allows for the collection of stool in an internal pouch rather than an external bag. A segment of ileum, typically 45 to 60 centimeters in length, is mobilized and folded back on itself to form a reservoir or pouch, which can take the shape of an 'S' or 'J'. This pouch is designed to function as a storage area for fecal matter. The distal segment of the ileum is left approximately 15 centimeters long to create an ileal valve, which helps control the passage of stool. The procedure also involves the use of electrocautery to scarify the segment of ileum just distal to the reservoir, and adjacent mesentery is excised to facilitate the creation of the ileal valve. The final steps include securing the telescoped portion of the ileum to the pouch, suturing the pouch closed, and bringing the distal end of the ileum through the abdominal wall at a stoma site. A large-diameter plastic tube is placed in the stoma to assist with the expansion of the pouch over several weeks. This tube is occluded for progressively longer periods until the patient can tolerate occlusion for up to eight hours, at which point the tube is removed. Post-surgery, the patient is instructed to intubate the pouch through the ileal stoma several times a day to drain fecal matter, ensuring proper management of the newly created internal pouch.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 44151 is indicated for patients with conditions that necessitate the removal of the entire colon while preserving the rectum. Common indications for this procedure include:
The procedure for CPT® Code 44151 involves several critical steps to ensure the successful removal of the colon and the creation of a continent ileostomy:
After the completion of the procedure, patients typically require careful monitoring and management to ensure proper recovery. Post-operative care includes monitoring for any signs of infection at the stoma site, managing pain, and ensuring the patient is able to intubate the pouch effectively. Patients may need to follow a specific diet and receive education on how to care for the stoma and manage the continent ileostomy. Follow-up appointments are essential to assess the function of the ileal pouch and to make any necessary adjustments to the patient's care plan. Recovery time can vary, but patients are generally advised to avoid strenuous activities for a period to allow for proper healing.
| Short Descr | REMOVAL OF COLON/ILEOSTOMY | Medium Descr | COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST | Long Descr | Colectomy, total, abdominal, without proctectomy; with continent ileostomy | 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) | P1B - Major procedure - colectomy | MUE | 1 | CCS Clinical Classification | 78 - Colorectal resection |
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) |
| 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. | 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). | 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). | 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. | 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. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician |
|
Date
|
Action
|
Notes
|
|---|---|---|
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.