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The CPT® Code 44202 refers to a laparoscopic surgical procedure known as enterectomy, which involves the resection of a segment of the small intestine. This procedure is performed through small incisions in the abdominal wall, utilizing a laparoscope, which is a specialized instrument that allows for visualization of the abdominal cavity. The term "enterectomy" specifically denotes the surgical removal of a portion of the small intestine, and in this case, it is a single resection followed by anastomosis, which is the surgical connection of the remaining segments of the intestine. The procedure is typically indicated for various conditions affecting the small intestine, such as tumors, strictures, or inflammatory diseases. The laparoscopic approach is favored due to its minimally invasive nature, which generally results in reduced postoperative pain, shorter recovery times, and minimal scarring compared to traditional open surgery. The detailed steps of the procedure involve careful manipulation and resection of the bowel, ensuring that the remaining segments are properly joined to maintain intestinal continuity.
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The procedure described by CPT® Code 44202 is indicated for various conditions affecting the small intestine. These may include:
The procedure for CPT® Code 44202 involves several critical steps to ensure successful resection and anastomosis of the small intestine. The process begins with the creation of a small portal incision near the umbilicus, through which a trocar is inserted to establish pneumoperitoneum, allowing for the inflation of the abdominal cavity. Following this, additional portal incisions are made, and trocars are placed in the upper and lower quadrants of the abdomen to facilitate access to the surgical site. Once the abdominal cavity is adequately inspected, the segment of the small intestine that requires resection is identified and mobilized to allow for its exteriorization. Next, the distal resection site is located, and the intestine is clamped and divided at this point. To facilitate the exteriorization of the bowel, the incision at one of the abdominal trocar sites is enlarged. The proximal segment of the small intestine is then brought through this incision, allowing it to be exteriorized beyond the proximal resection site. The proximal resection site is identified and resected using surgical clips and a harmonic scalpel to ensure precise cutting with minimal bleeding. After the resection, the remaining segment of the exteriorized small intestine is returned to the abdominal cavity, and the incision made for exteriorization is closed. The final step involves anastomosing the distal and proximal segments of the small intestine, which is accomplished by suturing or stapling them together. The small bowel is clamped above and below the segment to be removed, and the intestine is divided at the identified resection sites. The proximal and distal segments are then sutured or stapled together, and the clamps are released to restore intestinal continuity.
Post-procedure care following a laparoscopic enterectomy involves monitoring the patient for any signs of complications, such as infection or leakage at the anastomosis site. Patients are typically advised to follow a specific diet as they recover, starting with clear liquids and gradually progressing to solid foods as tolerated. Pain management is also an essential aspect of post-operative care, with medications prescribed to alleviate discomfort. The expected recovery time may vary, but many patients can return to normal activities within a few weeks, depending on their overall health and the extent of the surgery. Follow-up appointments are crucial to ensure proper healing and to address any concerns that may arise during the recovery process.
| Short Descr | LAP ENTERECTOMY | Medium Descr | LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA | Long Descr | Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis | 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) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 75 - Small bowel resection |
This is a primary code that can be used with these additional add-on codes.
| 44203 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Laparoscopy, surgical; each additional small intestine resection and anastomosis (List separately in addition to code for primary procedure) | 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) | 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) |
| 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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. | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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) | ST | Related to trauma or injury | 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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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2002-01-01 | Changed | Code description changed. |
| 2000-01-01 | Added | First appearance in code book in 2000. |
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