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The CPT® Code 44158 refers to a surgical procedure known as a total colectomy with proctectomy, which is performed through an abdominal incision. This complex operation involves the complete removal of the colon and rectum, along with the creation of an ileoanal anastomosis and an ileal reservoir, which can take the form of either an S or J pouch. The procedure is designed to allow for the storage and passage of stool in patients who no longer have a functioning large intestine. During the operation, the surgeon mobilizes the entire colon and rectum, carefully dividing and excising the colon between the terminal ileum and the distal rectum. The distal rectum may undergo a mucosectomy, where the mucosal lining is removed while preserving the underlying muscle structure. Subsequently, a segment of the terminal ileum is folded to create a pouch, which is then anastomosed to the anus, facilitating normal stool passage. Additionally, a loop ileostomy may be created, where a portion of the ileum is brought out through the abdominal wall to allow for temporary stool diversion while the anal anastomosis heals. This procedure is typically indicated for various conditions affecting the colon and rectum, providing patients with a functional means of stool elimination post-surgery.
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The total colectomy with proctectomy, as described by CPT® Code 44158, is indicated for several specific conditions affecting the colon and rectum. These may include:
The procedure for CPT® Code 44158 involves several critical steps that ensure the successful removal of the colon and rectum while creating a functional ileoanal anastomosis. The steps include:
After the completion of the total colectomy with proctectomy, patients typically require careful monitoring and post-operative care. This includes managing pain, monitoring for signs of infection, and ensuring proper healing of the surgical sites. Patients may initially have a temporary ileostomy, which will require care and management until it is reversed or until the anastomosis has healed sufficiently. Dietary modifications may also be necessary as the patient adjusts to the absence of the colon. Follow-up appointments are essential to assess recovery and the functionality of the ileoanal anastomosis, ensuring that the patient can resume normal bowel function.
| Short Descr | COLECTOMY W/NEO-RECTUM POUCH | Medium Descr | COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR | Long Descr | Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed | 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 | 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. | 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). | 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). | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2007-01-01 | Added | First appearance in code book in 2007. |
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