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The procedure described by CPT® Code 44211 involves a laparoscopic surgical technique for performing a total abdominal colectomy, which is the complete removal of the colon. This procedure is accompanied by a proctectomy, which entails the surgical removal of the rectum. A key component of this operation is the creation of an ileoanal anastomosis, where the ileum, the last part of the small intestine, is surgically connected to the anus. Additionally, an ileal reservoir, which can be shaped like an S or a J, is formed to serve as a storage pouch for stool, compensating for the absence of the large intestine. The procedure also includes the option of a loop ileostomy, where a loop of the ileum is brought out through the abdominal wall to create a temporary artificial opening for stool passage. This allows for the ileum to empty while the newly formed anal connection heals. The operation may also involve rectal mucosectomy, which is the removal of the mucosal lining of the rectum, if deemed necessary. The use of carbon dioxide gas for insufflation is a standard practice in laparoscopic surgeries, allowing for better visualization and access to the abdominal cavity through small incisions made in the abdomen. Overall, this complex surgical procedure is designed to restore bowel function and manage conditions affecting the colon and rectum.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 44211 is indicated for various conditions affecting the colon and rectum. These may include:
The surgical procedure begins with the patient being placed under general anesthesia. Following this, the abdomen is insufflated with carbon dioxide gas through the umbilicus to create a working space for the laparoscopic instruments. The surgeon then makes several small incisions in the abdominal wall, typically in the right and left mid-quadrant and suprapubic area, to insert the laparoscopic instruments. The next step involves mobilizing the entire colon and rectum, which requires careful dissection to free these structures from surrounding tissues.
Once mobilized, the colon is divided between the terminal portion of the ileum and the distal rectum, allowing for the complete removal of the colon. During this process, the remaining distal rectum may undergo a mucosectomy, where the mucosal lining is stripped away while preserving the underlying muscle. This step is crucial for preparing the rectal cuff for the subsequent anastomosis.
After the colon is removed, a portion of the terminal ileum is folded upon itself to create an ileal reservoir, which can be configured in an S or J shape. This pouch is then brought through the remaining muscle cuff of the distal rectum and sutured to the anus, establishing the ileoanal anastomosis. This connection allows for the storage and passage of stool in the absence of the large intestine.
To facilitate recovery and manage stool output during the healing process, a loop of the ileum above the newly created anastomosis is brought out through an opening in the abdominal wall, forming a loop ileostomy. This temporary artificial opening allows the ileum to empty while the anal anastomosis heals, ensuring that the patient can manage bowel function effectively post-surgery.
After the completion of the procedure, the patient is typically monitored in a recovery area until the effects of anesthesia wear off. Post-operative care includes managing pain, monitoring for any signs of complications such as infection or anastomotic leakage, and ensuring proper hydration and nutrition. Patients may initially be placed on a clear liquid diet, gradually progressing to a regular diet as tolerated. Follow-up appointments are essential to assess the healing of the anastomosis and the function of the ileal reservoir. Education on managing the loop ileostomy, if applicable, is also provided to ensure the patient is comfortable and knowledgeable about their care during recovery.
| Short Descr | LAP COLECTOMY W/PROCTECTOMY | Medium Descr | LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS | Long Descr | Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes 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.
| 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) |
| 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. | 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.) | 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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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2007-01-01 | Changed | Code description changed. |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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