2025 CPT code 44157
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Total abdominal colectomy with proctectomy, ileoanal anastomosis, loop ileostomy, and rectal mucosectomy.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the current CPT coding guidelines and your specific payer's guidelines for applicable modifiers.
Medical necessity for this procedure is typically established in cases of severe inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease) unresponsive to medical management, or in cases of colorectal cancer.
The surgeon is responsible for all aspects of the procedure, including preoperative planning, intraoperative technique, and postoperative care.
In simple words: The surgeon removes the entire colon and rectum.They then connect the end of the small intestine to the anus. A temporary opening is made in the abdomen to drain the intestines, which will be closed later. The lining of the rectum is also removed.
This procedure involves the complete surgical removal of the colon and rectum (total abdominal colectomy with proctectomy).The ileum (the last part of the small intestine) is then connected to the anus (ileoanal anastomosis). A temporary opening (loop ileostomy) is created in the ileum and brought to the abdominal wall to allow for bowel drainage. Additionally, the mucous membrane of the rectum is removed (rectal mucosectomy).
Example 1: A patient with ulcerative colitis refractory to medical management undergoes a total colectomy with proctectomy and ileoanal anastomosis. A loop ileostomy is created for temporary diversion., A patient with familial adenomatous polyposis (FAP) undergoes a prophylactic total colectomy with proctectomy and ileoanal anastomosis to reduce cancer risk. A loop ileostomy is created for temporary diversion., A patient with rectal cancer requiring a total colectomy and proctectomy undergoes the procedure; an ileoanal anastomosis is performed with a loop ileostomy for temporary diversion. Rectal mucosectomy is performed as part of the oncologic resection.
* Preoperative diagnosis and justification for the procedure.* Detailed operative report describing the surgical steps, including extent of resection, reconstruction, and creation of the ileostomy.* Pathological report confirming the diagnosis and confirming the adequacy of resection margins.* Postoperative progress notes, including assessment of the ileostomy function and overall recovery.* Any imaging studies that were performed, such as colonoscopy or CT scan.
** This procedure is complex and requires a high degree of surgical skill.Ensure proper documentation to support medical necessity and accurate coding.
- Revenue Code: This will vary depending on the payer and facility.Refer to your specific payer guidelines and revenue code mappings.
- RVU: RVUs will vary depending on geographic location, facility type (inpatient/outpatient), and other factors. Consult your specific payer's fee schedule for accurate RVU values.
- Global Days : The global period for this procedure will vary depending on the payer and specific circumstances. It is recommended to consult the payer's guidelines for the relevant global period.
- Payment Status: Active
- Modifier TC rule: The application of TC (technical component) modifiers would depend on the specific components performed by different providers.Consult your specific payer's guidelines for details.
- Fee Schedule : Historical fee schedule data will vary depending on the payer and year.Consult your payer's historical fee schedules for specific information.
- Specialties:Colorectal Surgery, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center