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Intraoperative colonic lavage is a specialized medical procedure aimed at cleansing the colon of fecal matter, which is particularly important prior to conducting a colectomy or colon repair. This procedure is performed during surgery and is essential for ensuring that the surgical field is clear of any obstructive material that could complicate the primary surgical intervention. The process begins with the mobilization of the splenic flexure, allowing the surgeon to effectively manipulate the colon. Manual massage is then employed to move the contents of the colon into the descending colon, facilitating the removal of fecal matter. To aid in this process, a drain is inserted into the descending colon, which serves as an outlet for the evacuated fecal material. An incision is made in the cecum, where a catheter is introduced. This catheter is crucial for delivering an irrigating solution into the colon, which, when combined with the manual massage, helps to break up any solid stool present. The combination of stool and irrigating solution is then expelled from the descending colon through the drain. Once the lavage is completed, the catheter and drain are removed, and the incision in the cecum is closed. Following this preparatory step, the surgeon can proceed with the definitive surgical procedure, ensuring optimal conditions for the operation.
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The intraoperative colonic lavage procedure is indicated in specific surgical scenarios where a clear colon is essential for the success of subsequent surgical interventions. The following conditions warrant the performance of this procedure:
The intraoperative colonic lavage procedure consists of several critical steps that ensure effective cleansing of the colon. Each step is designed to facilitate the removal of fecal matter and prepare the colon for subsequent surgical procedures.
After the intraoperative colonic lavage is completed, the focus shifts to post-procedure care. The incision in the cecum is closed, and the surgical team monitors the patient for any signs of complications. It is essential to ensure that the surgical site is healing properly and that there are no signs of infection or other adverse effects. The patient may be observed for a period to assess recovery and readiness for the subsequent definitive surgical procedure. Proper documentation of the lavage procedure is also critical for coding and billing purposes, as it is reported separately in addition to the primary procedure.
| Short Descr | INTRAOP COLON LAVAGE ADD-ON | Medium Descr | INTRAOPERATIVE COLONIC LAVAGE | Long Descr | Intraoperative colonic lavage (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 96 - Other OR lower GI therapeutic procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 44140 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Colectomy, partial; with anastomosis | 44145 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Colectomy, partial; with coloproctostomy (low pelvic anastomosis) | 44150 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy | 44604 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomy |
| 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. | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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| 2003-01-01 | Added | First appearance in code book in 2003. |
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