CPT® Code 44320

The CPT® Code 44320 refers to the surgical procedure of creating a colostomy or a skin level cecostomy. This procedure involves making a midline incision in the abdominal wall to access the peritoneal cavity. During the operation, the abdomen is carefully examined, and any adhesions that may hinder the procedure are lysed, which means they are surgically separated using both blunt and sharp dissection techniques. The specific segment of the colon or cecum that will be brought to the skin surface is identified and mobilized to ensure proper placement. A secondary incision is then made in the lower abdomen, typically on the right side, where a stoma site is prepared. To facilitate the exteriorization of the colon or cecum, clamps are applied above and below the intended transection site. The segment of the colon or cecum is then transected, and the distal segment is closed with sutures before the distal clamp is removed. The proximal segment is exteriorized, the clamp is taken off, and the colon or cecum is everted, meaning it is folded back on itself. This everted segment is then sutured to the skin and subcutaneous tissue to create a stoma. After the stoma is established, the abdominal incision is closed, and a stomal appliance is placed to manage the output from the stoma. It is important to note that this code is used when the procedure is performed without obtaining multiple biopsies; if multiple biopsies of the intestinal mucosa are taken, CPT® Code 44322 should be used instead. This distinction is crucial for accurate coding and billing purposes.