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Official Description

Laparoscopy, surgical; ileostomy or jejunostomy, non-tube

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 44187 refers to a laparoscopic surgical technique for creating a non-tube ileostomy or jejunostomy. This minimally invasive approach begins with the creation of a small incision near the umbilicus, through which a trocar is inserted to establish pneumoperitoneum, allowing for the inflation of the abdominal cavity with gas. Additional incisions are made in the upper and lower quadrants of the abdomen, where more trocars are placed to facilitate the surgical procedure. The surgeon inspects the abdominal cavity for any abnormalities, such as adhesions, which may need to be lysed using both blunt and sharp dissection techniques. In this specific procedure, the focus is on exteriorizing a segment of the ileum or jejunum without the use of a tube, as opposed to other related procedures that may involve tube placement for feeding or decompression. The surgeon identifies and mobilizes the segment of intestine to be exteriorized, prepares the stoma site, and clamps the intestine above and below the planned transection site. After preparing the stoma site, the jejunum or ileum is exteriorized through the incision, transected, and the distal segment is closed with sutures. The proximal segment is then everted and sutured to the skin and subcutaneous tissue, ensuring a secure stoma. The procedure concludes with the re-establishment of pneumoperitoneum, inspection of the abdominal cavity and the stoma for any tension, removal of the laparoscope and trocars, closure of the incisions, and placement of a stoma appliance to manage output from the newly created stoma.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 44187 is indicated for patients requiring the creation of a non-tube ileostomy or jejunostomy. This may be necessary in cases where there is a need for intestinal diversion due to various gastrointestinal conditions. The specific indications include:

  • Intestinal Obstruction: Situations where there is a blockage in the intestines that cannot be resolved through other means.
  • Inflammatory Bowel Disease: Conditions such as Crohn's disease or ulcerative colitis that may necessitate surgical intervention.
  • Malignancies: Tumors in the gastrointestinal tract that require resection or diversion of intestinal flow.
  • Trauma: Injuries to the intestines that may require surgical intervention to create a stoma for waste management.

2. Procedure

The procedure for CPT® Code 44187 involves several critical steps to successfully create a non-tube ileostomy or jejunostomy. The steps are as follows:

  • Step 1: A small portal incision is made near the umbilicus, and a trocar is inserted to establish pneumoperitoneum, which inflates the abdominal cavity with gas to provide a working space for the surgeon.
  • Step 2: Additional portal incisions are made in the upper and lower quadrants of the abdomen, where more trocars are placed to facilitate access to the abdominal cavity.
  • Step 3: The abdominal cavity is inspected for any abnormalities, such as adhesions, which may need to be lysed using blunt and sharp dissection techniques.
  • Step 4: The segment of ileum or jejunum to be exteriorized is identified and mobilized. A trocar is placed in the planned stoma site to prepare for the exteriorization of the intestine.
  • Step 5: The jejunum or ileum is clamped above and below the planned transection site to control the flow of intestinal contents during the procedure.
  • Step 6: The stoma site is prepared around the previously placed trocar, and gas is released from the abdomen to facilitate the exteriorization of the intestine.
  • Step 7: The jejunum or ileum is exteriorized through the stoma incision, and the segment is transected to create the stoma.
  • Step 8: The distal segment of the intestine is closed with sutures, and the clamp is removed to allow the distal segment to return to the abdomen.
  • Step 9: The proximal clamp is removed, and the proximal segment of the jejunum or ileum is folded back on itself (everted) and sutured to the skin and subcutaneous tissue to secure the stoma.
  • Step 10: Pneumoperitoneum is re-established, and the abdomen along with the segment of exteriorized intestine is inspected to ensure that there is no tension on the stoma.
  • Step 11: Finally, the laparoscope and trocars are removed, the portal incisions are closed, and a stoma appliance is placed to manage output from the newly created stoma.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored for any immediate complications related to the surgery. Post-procedure care includes managing the stoma appliance, monitoring for signs of infection, and ensuring that the stoma is functioning properly. Patients may also receive instructions on dietary modifications and stoma care to promote healing and adaptation to the new intestinal configuration. Follow-up appointments are essential to assess the stoma's condition and the patient's overall recovery.

Short Descr LAP ILEO/JEJUNO-STOMY
Medium Descr LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE
Long Descr Laparoscopy, surgical; ileostomy or jejunostomy, non-tube
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 73 - Ileostomy and other enterostomy

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

49327 Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure)
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).
GC This service has been performed in part by a resident under the direction of a teaching physician
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).
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).
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
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
ET Emergency services
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
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
RT Right side (used to identify procedures performed on the right side of the body)
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
Date
Action
Notes
2011-01-01 Changed Short description changed.
2006-01-01 Added First appearance in code book in 2006.
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