2025 CPT code 44150
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Total abdominal colectomy without proctectomy; with ileostomy or ileoproctostomy.
Modifiers may be appended to 44150 as needed to clarify specific aspects of the procedure. For example, Modifier 51 might be used if multiple procedures are performed concurrently. Consult the current CPT guidelines for specific modifier application rules.
Medical necessity for total colectomy may be established by documented evidence of a disease process affecting the colon (e.g., cancer, inflammatory bowel disease, severe diverticulitis) that is unresponsive to conservative management and threatens the patient's health or life.The decision to perform an ileostomy or ileoproctostomy is typically based on the patient's specific condition and the surgeon's judgment.
The surgeon's responsibilities include pre-operative assessment, surgical planning, performing the total abdominal colectomy (including meticulous dissection, ligation of vessels, and bowel transection), creation of the ileostomy or ileoproctostomy, and post-operative care including monitoring for complications.
In simple words: The surgeon removes the entire colon through a cut in the belly.The end of the small intestine is then either connected to the skin (creating an opening for waste to pass through) or reconnected to the rectum.
This procedure involves the complete surgical removal of the colon through an abdominal incision, without the removal of the rectum.The procedure concludes with the creation of either an ileostomy (connecting the ileum to the abdominal wall) or an ileoproctostomy (connecting the ileum to the rectum).
Example 1: A patient with ulcerative colitis requiring total colectomy with ileostomy due to severe inflammation and disease extent unresponsive to medical management., A patient with familial adenomatous polyposis (FAP) undergoing prophylactic total colectomy with ileo-rectal anastomosis to prevent colorectal cancer., A patient with colon cancer involving a significant portion of the colon, necessitating total colectomy with an ileostomy due to the extensive nature of the resection needed for clear margins.
Complete operative report detailing the procedure, including specifics on the type of anastomosis, any complications encountered, and the extent of the resection.Pre-operative and post-operative assessments, imaging studies (colonoscopy, CT scan), pathology report confirming diagnosis and margins, and any other relevant information.Appropriate documentation for medical necessity supporting the need for surgical intervention.
** The choice between ileostomy and ileoproctostomy depends on factors such as the patient's overall health, the extent of the disease, and the surgeon's judgment. Always ensure accurate documentation to justify the chosen approach.