How To Use CPT Code 44605

CPT 44605 describes the procedure of suturing a tear or hole in the large intestine, also known as colorrhaphy, along with the creation of a colostomy. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 44605?

CPT 44605 is used to describe the surgical procedure of repairing a tear or hole in the large intestine, also known as colorrhaphy, along with the creation of a colostomy. This procedure is performed to allow the damaged tissue and sutured area time to heal and prevent infection from fecal contamination.

2. Official Description

The official description of CPT code 44605 is: ‘Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); with colostomy.’

3. Procedure

1. The patient is positioned supine on the operating table and prepared for the procedure.
2. An incision is made over the affected area of the large intestine.
3. The provider sutures one or more tears in the wall of the large intestine in layers.
4. The abdomen is lavaged with an antibiotic solution or normal saline to clean out any leakage of the bowel or bleeding.
5. The lavage fluid is suctioned out.
6. A segment of colon above the injured area is identified and separated from the lower portion.
7. The lower part of the colon is closed off, and the upper portion is brought up to the abdominal wall.
8. The upper portion is attached to a surgically created stoma, diverting intestinal contents into a bag worn externally during the healing process.
9. The provider checks for bleeding, removes any instruments, and closes the abdominal incision in layers.

4. Qualifying circumstances

CPT 44605 is performed in cases where there is a tear or hole in the large intestine due to conditions such as a perforated ulcer, diverticulum, wound, injury, or rupture. The procedure is necessary to repair the damage and prevent further complications. The creation of a colostomy is also a qualifying circumstance for this code.

5. When to use CPT code 44605

CPT code 44605 should be used when a provider performs the procedure of suturing a tear or hole in the large intestine, along with the creation of a colostomy. It is important to accurately document the specific indications for the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 44605, the following documentation is required:

• Indication for the procedure, such as a perforated ulcer, diverticulum, wound, injury, or rupture
• Details of the tear or hole in the large intestine
• Description of the suturing technique used
• Documentation of the creation of a colostomy
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 44605, ensure that the procedure performed includes the repair of a tear or hole in the large intestine and the creation of a colostomy. It is important to follow the specific guidelines provided by the payer regarding the use of this code and any associated modifiers. Additionally, be aware of any bundling or unbundling rules that may apply to this procedure.

8. Historical information

CPT 44605 was added to the Current Procedural Terminology system on January 1, 1990. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A surgeon performs colorrhaphy with colostomy for a patient with a perforated ulcer in the large intestine.
2. A gastroenterologist sutures a tear in the large intestine and creates a colostomy for a patient with a diverticulum.
3. A general surgeon repairs a wound in the large intestine and performs a colostomy for a patient with an injury.
4. A colorectal surgeon sutures multiple perforations in the large intestine and creates a colostomy for a patient with a rupture.
5. A surgical team performs colorrhaphy with colostomy for a patient with multiple perforations in the large intestine due to diverticulitis.