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The procedure described by CPT® Code 44157 involves a total abdominal colectomy with proctectomy, which is a surgical operation that entails the complete removal of the colon and rectum. This procedure is performed through an abdominal incision, allowing the surgeon to access the entire colon and rectum for mobilization. The term "proctectomy" refers specifically to the surgical removal of the rectum. Following the removal, an ileoanal anastomosis is created, which is a surgical connection between the end of the ileum (the last part of the small intestine) and the anus. This connection allows for the passage of stool through the anus after the surgery. Additionally, the procedure may include a loop ileostomy, which is an artificial opening created in the abdominal wall to allow the ileum to empty its contents externally while the newly formed anastomosis heals. A rectal mucosectomy may also be performed, which involves the removal of the mucosal lining of the rectum. This comprehensive approach is typically indicated for conditions affecting the colon and rectum, ensuring that the patient can maintain bowel function post-surgery.
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The procedure described by CPT® Code 44157 is indicated for various conditions affecting the colon and rectum. These may include:
The procedure involves several critical steps to ensure the successful removal of the colon and rectum while establishing a new pathway for stool elimination.
After the completion of the procedure, patients typically require close monitoring in a postoperative setting. Recovery may involve managing pain, monitoring for signs of infection, and ensuring proper healing of the anastomosis. Patients may initially have a temporary ileostomy, which will be assessed for function and output. Once the anastomosis has healed adequately, the ileostomy may be reversed, allowing for normal bowel function. Follow-up care is essential to monitor for any complications and to support the patient's recovery process.
| Short Descr | COLECTOMY W/ILEOANAL ANAST | Medium Descr | COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST | Long Descr | Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 78 - Colorectal resection |
This is a primary code that can be used with these additional add-on codes.
| 96547 | Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure) | 96548 | Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2007-01-01 | Added | First appearance in code book in 2007. |
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