2025 CPT code 44151
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Colectomy, total, abdominal, without proctectomy; with continent ileostomy
Modifiers may be applicable in certain situations (e.g., modifier 22 for increased procedural services).
Medical necessity for a total colectomy with continent ileostomy is determined by factors like the severity of the underlying condition (e.g., ulcerative colitis, Crohn's disease, familial adenomatous polyposis), the failure of conservative medical management, and the patient's overall health status. Preserving the rectum can be beneficial for maintaining some level of continence, but this decision is made on a case-by-case basis depending on the patient's condition and surgical considerations.
The surgeon performs a midline abdominal incision, dissects to the colon, frees it from attachments, ligates blood vessels, divides the terminal ileum, removes the colon, forms an ileal pouch, and creates the continent ileostomy.
In simple words: The surgeon removes the entire colon but leaves the rectum.A small pouch is made from the end of the small intestine and attached to an opening on the belly. This pouch allows for controlled emptying of bowel movements, without needing to wear a bag.
This procedure involves the removal of the entire colon without removing the rectum.A continent ileostomy is created from the terminal ileum, which is then connected to the skin of the abdomen. This allows for the controlled elimination of waste without the need for an external appliance.
Example 1: A patient with severe ulcerative colitis unresponsive to medical therapy requires a total colectomy with continent ileostomy to alleviate symptoms and prevent disease progression. The rectum is preserved., A patient with familial adenomatous polyposis undergoes a total colectomy with continent ileostomy to prevent the development of colon cancer. The rectum is spared., A patient with Crohn's disease affecting the entire colon but sparing the rectum requires a total colectomy with continent ileostomy to manage symptoms and remove the diseased portion of the bowel.
Operative report detailing the procedure, including the extent of the colectomy, the creation of the ileal pouch, and the type of ileostomy created. Preoperative diagnostic studies justifying the medical necessity of the procedure (e.g., colonoscopy, biopsy results, imaging studies). Documentation of medical necessity should specify why the rectum was preserved.
** It is important to distinguish this code from other colectomy codes that include proctectomy (removal of the rectum) or those involving different types of ostomies. If the procedure becomes significantly more complex due to unforeseen circumstances, modifier 22 may be considered.
- Payment Status: Active - Subject to Inpatient Only (IPO) list edit as of 2017.
- Specialties:General Surgery, Colorectal Surgery
- Place of Service:Inpatient Hospital