How To Use CPT Code 44156

CPT 44156 describes a specific surgical procedure known as colectomy with continent ileostomy. This article will provide an overview of the code, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of when CPT 44156 may be used.

1. What is CPT Code 44156?

CPT 44156 is a code used to describe a surgical procedure called colectomy with continent ileostomy. This procedure involves the removal of the entire colon and rectum, and the creation of an ileal pouch from the terminal ileum. The ileal pouch is then connected to the skin of the abdomen, creating a continent ileostomy. Unlike a traditional ileostomy, a continent ileostomy does not require the patient to wear an external appliance constantly. Instead, the patient manually empties the pouch several times a day.

2. Official Description

The official description of CPT code 44156 is: ‘Colectomy, total, abdominal, with proctectomy; with continent ileostomy.’

3. Procedure

1. The surgeon begins by making a midline abdominal incision from the xiphoid to the pubis.
2. Next, the surrounding structures are dissected to reach the affected area of the colon and rectum.
3. The surgeon then frees the colon and rectum from their attachments and ligates the blood vessels.
4. The upper part of the rectum and terminal ileum are divided and removed.
5. The remaining rectum is also removed.
6. The surgeon brings the terminal ileum out to the skin of the abdomen through a separate incision, creating a continent ileostomy.
7. After checking for bleeding and removing any instruments, the incision in the abdomen is closed.

4. Qualifying circumstances

CPT 44156 is typically performed on patients with conditions such as colorectal cancer or Crohn’s disease. These conditions may cause pain in the abdomen, fever, and weight loss. The surgery is performed by a qualified surgeon and requires the removal of the entire colon and rectum, along with the creation of a continent ileostomy.

5. When to use CPT code 44156

CPT code 44156 should be used when a colectomy with continent ileostomy is performed. It is important to accurately document the specific procedure performed to ensure proper coding and billing.

6. Documentation requirements

To support a claim for CPT 44156, the surgeon must document the following information:

• Patient’s diagnosis and the need for colectomy with continent ileostomy
• Details of the surgical procedure performed, including the specific steps taken
• Date of the surgery
• Any complications or unexpected findings during the procedure
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 44156, it is important to ensure that the procedure performed meets the criteria outlined in the code description. Additionally, it is important to follow any specific billing guidelines provided by the payer. It is also important to review other codes related to colectomy to ensure accurate coding and billing.

8. Historical information

CPT code 44156 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient with colorectal cancer undergoes a colectomy with continent ileostomy to remove the affected colon and rectum.
2. A patient with Crohn’s disease undergoes a colectomy with continent ileostomy to alleviate symptoms and improve quality of life.
3. A surgeon performs a colectomy with continent ileostomy on a patient with a history of chronic ulcerative colitis.
4. A patient with a genetic predisposition to colon cancer undergoes a prophylactic colectomy with continent ileostomy to reduce the risk of developing the disease.
5. A patient with a severe case of diverticulitis undergoes a colectomy with continent ileostomy to alleviate symptoms and prevent complications.
6. A surgeon performs a colectomy with continent ileostomy on a patient with a large polyp in the colon that cannot be removed through other means.
7. A patient with a history of multiple colon polyps undergoes a colectomy with continent ileostomy to reduce the risk of developing cancer.
8. A surgeon performs a colectomy with continent ileostomy on a patient with a rare congenital condition affecting the colon and rectum.
9. A patient with a history of chronic constipation undergoes a colectomy with continent ileostomy to improve bowel function.
10. A surgeon performs a colectomy with continent ileostomy on a patient with a severe case of inflammatory bowel disease that is unresponsive to other treatments.