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The CPT® Code 44156 refers to a total colectomy performed through an abdominal approach, which includes the removal of the entire colon along with a proctectomy, and the creation of a continent ileostomy. This surgical procedure is indicated for patients with various conditions affecting the colon and rectum, necessitating the complete removal of these structures. The term 'continent ileostomy' signifies that a surgically constructed internal pouch is created to collect stool, allowing for controlled evacuation by the patient. The procedure begins with a midline abdominal incision, through which the abdominal cavity is accessed and inspected. The entire colon is mobilized by carefully dividing its attachments and separating it from surrounding structures. The mesentery, which is the tissue that supports the colon, is also divided to facilitate the removal of the colon. Following the mobilization, the rectum is addressed, involving the identification and dissection of the superior rectal vessels, which are then ligated and divided. The procedure culminates in the creation of a reservoir from a segment of the ileum, which is designed to function as a storage pouch for fecal matter, allowing the patient to manage bowel movements more effectively. This complex surgical intervention requires meticulous technique and careful postoperative management to ensure optimal recovery and function of the newly created ileostomy.
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The procedure described by CPT® Code 44156 is indicated for patients with specific gastrointestinal conditions that necessitate the removal of the colon and rectum. These indications may include:
The procedure for CPT® Code 44156 involves several critical steps, each essential for the successful completion of the total colectomy with proctectomy and the creation of a continent ileostomy:
Post-procedure care following a total colectomy with proctectomy and continent ileostomy creation involves several important considerations. Patients will typically require monitoring for complications such as infection, bleeding, or bowel obstruction. Pain management is also a critical aspect of recovery, as patients may experience discomfort from the surgical site. The stoma site will need regular care to ensure proper healing and function. Patients will be educated on how to manage their new ileostomy, including how to intubate the pouch and drain fecal matter effectively. Follow-up appointments will be necessary to assess the healing process and the function of the ileostomy, as well as to provide ongoing support and education regarding dietary adjustments and lifestyle changes that may be needed post-surgery. Overall, a multidisciplinary approach involving surgeons, nurses, and dietitians is essential for optimal recovery and adaptation to the changes following this extensive surgical procedure.
| Short Descr | REMOVAL OF COLON/ILEOSTOMY | Medium Descr | COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST | Long Descr | Colectomy, total, abdominal, with 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. | 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. | 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. | 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 |
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| Pre-1990 | Added | Code added. |
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