2025 CPT code 44605
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Intestines (Except Rectum) Surgery Feed
Repair of large intestine tear or hole with sutures and abdominal lavage; with colostomy.
Modifiers may be applicable depending on the circumstances of the procedure.For instance, modifier 22 may be used if the surgical work involved is significantly greater than usual.Modifiers 51 and 52 may apply in cases of multiple procedures or reduced services.Always refer to the CPT® guidelines for appropriate modifier usage.
Medical necessity for code 44605 is established when there is a documented perforation or tear in the large intestine necessitating surgical repair.The colostomy is usually considered medically necessary to protect the surgical repair and prevent infection due to fecal contamination.The documentation must clearly demonstrate the presence of the perforation, its severity, and the clinical rationale for surgical intervention and the creation of the colostomy.
The clinical responsibility lies with the surgeon who performs the procedure. This includes pre-operative preparation, the surgical repair of the intestinal perforation and creation of the colostomy, post-operative care, and follow-up.The surgeon is responsible for ensuring the patient's safety and well-being throughout the procedure and recovery period.
In simple words: The doctor repairs a hole or tear in the large intestine with stitches and cleans the abdomen. They also create a colostomy, bringing a section of the large intestine through the abdominal wall to create an opening for waste to be collected in a bag outside the body. This is done to help the damaged area heal and prevent infection.
This CPT code describes the surgical repair of a tear or perforation in the large intestine (colon) using sutures, followed by irrigation (lavage) of the abdominal cavity with an antibiotic solution or normal saline.A colostomy is also performed to divert fecal matter externally, allowing the repaired area to heal without contamination. The procedure involves an incision over the affected area, layered suturing of the intestinal perforation, abdominal lavage and suction, isolation and closure of the lower colon segment, creation of a stoma on the abdominal wall, attachment of the upper colon segment to the stoma to create a colostomy, hemostasis, and closure of the abdominal incision.
Example 1: A patient presents with symptoms of a perforated diverticulum in the sigmoid colon, resulting in peritonitis. The surgeon performs a resection of the perforated segment, repair of the remaining colon using sutures, and creation of a temporary diverting colostomy. Code 44605 is used to describe the surgical repair of the perforation with the creation of a colostomy., A patient sustains a penetrating injury to the abdomen, resulting in a large perforation in the transverse colon. The surgeon performs an exploratory laparotomy, repairs the perforation using layered sutures, and creates a colostomy to protect the suture line. The surgeon bills for code 44605, reflecting the repair of the perforation and creation of the colostomy., A patient undergoes a colectomy for colon cancer, and during surgery, a previously undiagnosed perforation is identified in an adjacent area of the colon. The surgeon repairs the perforation, performs the colectomy, and creates a temporary colostomy. Code 44605 can be used to describe the repair of the unplanned perforation with the creation of the colostomy, while another code would be used for the colectomy itself.
Complete operative report detailing the surgical approach, description of the perforation (location, size, cause), technique used for repair (suturing technique), type of lavage solution used, and the creation of the colostomy. Preoperative and postoperative diagnoses, imaging reports, and pathology reports (if applicable) should also be included.The medical record must support the medical necessity of the procedure.
** This code is used for the repair of a perforation in the large intestine, excluding the rectum. The creation of a colostomy is included in the code.Always ensure complete and accurate documentation to support the use of this code and avoid potential denials.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: The use of a technical component (TC) modifier would depend on the specific circumstances of the surgical scenario and the involvement of different professionals.Refer to the CPT® coding manual and local payer guidelines for clarification.This is likely not applicable.
- Specialties:General Surgery, Colorectal Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center