CPT® Code 44700

The procedure described by CPT® Code 44700 involves the exclusion of the small intestine from the pelvic cavity using either a mesh or other prosthetic material, or native tissue such as the bladder or omentum. This surgical intervention is primarily performed to protect the small intestine from potential radiation damage during radiation therapy. The process begins with the physician making an incision to open the abdomen, allowing access to the small intestine. Once accessed, the small intestine is carefully mobilized and elevated out of the pelvic cavity to ensure it is positioned away from the radiation field. A piece of mesh is then tailored to fit the specific dimensions required for the procedure. This mesh is placed beneath the small intestine and secured to surrounding anatomical structures with sutures, effectively keeping the intestines elevated and protected during subsequent radiation treatments. In some cases, alternative prosthetic devices may be utilized, such as a soft silicone plastic device that is designed to conform to the shape of the pelvis. This device is filled with saline and contrast material, enabling visualization on radiographic images. Radiographs are taken before each radiation session to confirm that the small intestine remains outside the radiation field. The prosthetic device is retained in place throughout the duration of the radiation therapy and is subsequently removed through a small incision after the device has been drained. Another option for this procedure includes the creation of an omental sling, where an omental flap is fashioned, positioned beneath the small intestine, and secured with sutures to maintain the elevation of the intestines away from the radiation exposure. This comprehensive approach ensures the protection of the small intestine during critical radiation therapy sessions.