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Official Description

Suture of mesentery (separate procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 44850 refers to the suture of the mesentery, which is classified as a separate procedure. The mesentery is a vital anatomical structure in the gastrointestinal tract, consisting of a fan-like arrangement of fibrous and fatty tissues. It serves as a supportive framework that contains essential blood vessels, lymphatic vessels, and nerves that supply the gastrointestinal organs. During this surgical procedure, a midline incision is made in the abdomen, allowing access to the peritoneal cavity. The peritoneum, which is the membrane lining the abdominal cavity, is opened to facilitate exploration. The surgeon aspirates any blood and fluid present in the abdominal cavity and conducts a thorough examination to assess the extent of any injuries. Once the injury to the mesentery is identified, measures are taken to control any bleeding, and any blood or clots are aspirated to maintain a clear surgical field. The integrity of the mesentery is carefully inspected to ensure that no major blood vessels, lymphatic structures, or nerves have sustained damage. Following this assessment, the mesentery is repaired using sutures to restore its function and structure. The operative site is then irrigated to cleanse the area, and the abdomen is re-examined for potential injuries to other organs or structures. Finally, the surgical wound is closed in a layered manner to promote optimal healing.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The suture of the mesentery, as described by CPT® Code 44850, is indicated in specific clinical scenarios where there is damage or injury to the mesentery that requires surgical intervention. The following conditions may warrant this procedure:

  • Trauma to the abdomen - This includes injuries resulting from blunt or penetrating trauma that may compromise the integrity of the mesentery.
  • Mesenteric hemorrhage - Situations where there is significant bleeding from the mesenteric vessels necessitating surgical repair.
  • Ischemia of the mesentery - Conditions where blood flow to the mesentery is compromised, leading to potential necrosis of the tissue.

2. Procedure

The procedure for suturing the mesentery involves several critical steps that ensure effective repair and restoration of the mesenteric structure. The following procedural steps are undertaken:

  • Step 1: Incision and Exploration - A midline incision is made in the abdomen, and the peritoneum is opened to gain access to the abdominal cavity. This initial step is crucial for allowing the surgeon to visualize the internal structures and assess any potential injuries.
  • Step 2: Aspiration of Fluids - Any blood and fluid present in the abdominal cavity are aspirated to create a clear surgical field. This step is essential for identifying the extent of injury and ensuring that the surgical area is free from obstructions.
  • Step 3: Injury Assessment - The abdomen is thoroughly explored to determine the extent of any injuries, particularly focusing on the mesentery. The surgeon identifies the specific location of the injury and evaluates the surrounding structures for any damage.
  • Step 4: Control of Bleeding - Once the injury is located, measures are taken to control any bleeding. This may involve cauterization or ligation of bleeding vessels to prevent further blood loss.
  • Step 5: Inspection of the Mesentery - The mesentery is carefully inspected to assess for damage to major blood vessels, lymphatic structures, or nerves. This evaluation is critical to ensure that all potential complications are addressed.
  • Step 6: Repair of the Mesentery - The mesentery is repaired using sutures, restoring its structural integrity and function. This step is vital for ensuring proper blood supply and lymphatic drainage to the gastrointestinal tract.
  • Step 7: Irrigation and Final Inspection - The operative site is irrigated to cleanse the area, and the abdomen is re-inspected for any evidence of injury to other organs or structures. This thorough examination helps to identify any additional issues that may require attention.
  • Step 8: Closure of the Wound - Finally, the operative wound is closed in a layered fashion, which promotes optimal healing and reduces the risk of complications.

3. Post-Procedure

After the suture of the mesentery is completed, post-procedure care is essential for ensuring proper recovery. Patients are typically monitored for any signs of complications, such as infection or bleeding. Pain management is provided as needed, and patients may be advised on dietary modifications during the initial recovery phase. Follow-up appointments are scheduled to assess healing and to ensure that the gastrointestinal function is restored. It is important for healthcare providers to educate patients on signs of potential complications that may require immediate medical attention.

Short Descr REPAIR OF MESENTERY
Medium Descr SUTURE MESENTERY SEPARATE PROCEDURE
Long Descr Suture of mesentery (separate procedure)
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 96 - Other OR lower GI therapeutic procedures
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.
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).
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.
47 Anesthesia by surgeon: regional or general anesthesia provided by the surgeon may be reported by adding modifier 47 to the basic service. (this does not include local anesthesia.) note: modifier 47 would not be used as a modifier for the anesthesia procedures.
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.
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.)
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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