CPT® Code 44150

The CPT® Code 44150 refers to a total colectomy performed through an abdominal approach, specifically without proctectomy, and includes the creation of either an ileostomy or an ileoproctostomy. This surgical procedure involves making a midline incision in the abdomen to access the abdominal cavity, allowing for a thorough inspection and mobilization of the entire colon. The process begins with the division of the lateral peritoneal attachments and the separation of the omentum from the transverse colon. The mesentery, which is the tissue that supports the colon, is then carefully divided, starting from the left colon and moving proximally. The bowel is subsequently divided at the rectosigmoid junction distally and just above the ileocecal valve proximally, leading to the removal of the diseased colon. In this procedure, if an ileostomy is created, the distal transection site at the rectosigmoid junction is closed with sutures, and the terminal ileum is brought through a separate incision, typically located in the right lower quadrant of the abdomen. The exteriorized segment of ileum is then folded back on itself and sutured to the skin and subcutaneous tissue to form a stoma. Alternatively, if an ileoproctostomy is performed, the terminal ileum is sutured directly to the rectum in an end-to-end configuration. This procedure is critical for patients with severe colon disease, as it effectively removes the affected portion of the colon while providing a new pathway for waste elimination through the ileostomy or ileoproctostomy.