How To Use CPT Code 44212

CPT 44212 describes a laparoscopic surgical procedure that involves the removal of the entire colon, known as total colectomy, along with the removal of the rectum, called proctectomy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 44212?

CPT 44212 is a code used to describe a laparoscopic surgical procedure that involves the removal of the entire colon, known as total colectomy, and the removal of the rectum, called proctectomy. This procedure is performed through small incisions in the abdomen using a camera and specialized instruments to visualize and remove the colon and rectum. It is typically performed for patients with conditions such as colorectal cancer or Crohn’s disease.

2. Official Description

The official description of CPT code 44212 is: ‘Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy.’ This code specifically refers to the laparoscopic approach for performing a total colectomy and proctectomy, with the creation of an ileostomy.

3. Procedure

1. The laparoscopic total colectomy and proctectomy procedure begins with the patient being appropriately prepped and anesthetized.
2. The surgeon makes small incisions in the abdomen, typically including one at the umbilicus, to insert a camera and specialized instruments.
3. The abdomen is insufflated with gas to create space and improve visualization of the surgical site.
4. The surgeon carefully frees the colon from its attachments and ligates the blood vessels supplying it.
5. The colon is transected at the ileocecal valve, which separates the large and small intestines, and at the distal rectum.
6. An ileostomy is created by connecting the terminal ileum of the small intestine to an incision in the abdominal wall, allowing for the emptying of the intestines.
7. Hemostasis is ensured, and the abdominal incisions, other than the ileostomy, are closed in layers.

4. Qualifying circumstances

CPT 44212 is typically performed for patients with conditions such as colorectal cancer or Crohn’s disease. It is important to note that this procedure is specific to the laparoscopic approach. If an open approach is used, a different CPT code should be used, such as 44155.

5. When to use CPT code 44212

CPT code 44212 should be used when a laparoscopic total colectomy and proctectomy procedure is performed, with the creation of an ileostomy. It is important to ensure that the procedure is performed laparoscopically and not through an open approach, as this would require a different CPT code.

6. Documentation requirements

To support a claim for CPT 44212, the following documentation should be included:

• Patient’s diagnosis and indication for the procedure
• Description of the laparoscopic approach
• Date of the procedure
• Details of the procedure, including the specific steps performed
• Any additional procedures or services provided
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT 44212, it is important to ensure that the procedure was performed laparoscopically and not through an open approach. If an open approach was used, a different CPT code should be reported. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines. Additionally, it is important to review any applicable modifiers that may be required for accurate billing.

8. Historical information

CPT code 44212 was added to the Current Procedural Terminology system on January 1, 2003. It has not undergone any updates since its addition. It is worth noting that Medicare made a change in 2017, adding CPT 44212 to the Inpatient Only (IPO) list.

9. Examples

1. A patient with colorectal cancer undergoes a laparoscopic total colectomy and proctectomy with ileostomy.
2. A patient with Crohn’s disease requires a laparoscopic total colectomy and proctectomy with ileostomy to manage their condition.
3. A laparoscopic total colectomy and proctectomy with ileostomy is performed on a patient with a history of ulcerative colitis.
4. A laparoscopic total colectomy and proctectomy with ileostomy is performed as part of a treatment plan for a patient with familial adenomatous polyposis.
5. A laparoscopic total colectomy and proctectomy with ileostomy is performed on a patient with a large colonic polyp that cannot be removed through other means.
6. A patient with a severe diverticular disease undergoes a laparoscopic total colectomy and proctectomy with ileostomy.
7. A laparoscopic total colectomy and proctectomy with ileostomy is performed on a patient with a history of chronic constipation and colonic inertia.
8. A patient with a recurrent colon cancer undergoes a laparoscopic total colectomy and proctectomy with ileostomy.
9. A laparoscopic total colectomy and proctectomy with ileostomy is performed on a patient with a large rectal polyp that cannot be removed through other means.