How To Use CPT Code 44640

CPT 44640 describes the closure of an intestinal cutaneous fistula, which is an abnormal passageway between the intestine and the skin. 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 44640?

CPT 44640 can be used to describe the closure of an intestinal cutaneous fistula, a condition where there is an abnormal connection between the intestine and the skin. This code is used when the provider performs a surgical procedure to close off the fistula and, if necessary, resects damaged sections of the intestine and joins the ends together to maintain a continuous digestive tract.

2. Official Description

The official description of CPT code 44640 is: ‘Closure of intestinal cutaneous fistula; with resection and anastomosis, if necessary.’

3. Procedure

1. The provider begins the procedure by making an incision over the area where the abnormal passage exits the skin.
2. They then free any intestines that are stuck to the abdominal wall and assess the extent of the damage.
3. If necessary, the provider resects damaged portions of the intestines and joins the ends together to completely remove the abnormal passageway.
4. In addition, they excise any damaged abdominal skin and close the incisions.
5. The provider ensures there is no bleeding, removes all instruments, and closes any remaining abdominal incisions in layers.

4. Qualifying circumstances

CPT 44640 is used to treat a fistula that has not responded to nonsurgical therapy. Patients with an intestinal cutaneous fistula, or enterocutaneous fistula, are eligible for this procedure. The provider must assess the patient’s condition and determine the need for surgical closure. It is important to note that this code does not include reconstruction of the abdominal wall beyond primary repair.

5. When to use CPT code 44640

CPT code 44640 should be used when the provider performs the closure of an intestinal cutaneous fistula, including any necessary resection and anastomosis. This code is appropriate when nonsurgical therapy has been unsuccessful in treating the fistula. It is important to use this code only for the closure of the fistula and not for any additional reconstruction of the abdominal wall.

6. Documentation requirements

To support a claim for CPT 44640, the provider must document the following information:

• Patient’s diagnosis of an intestinal cutaneous fistula
• Details of the procedure performed, including any resection and anastomosis
• Incision site and closure method
• Extent of damage and any complications encountered
• Any additional procedures performed, if applicable
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 44640, ensure that the procedure meets the criteria for closure of an intestinal cutaneous fistula. This code should not be reported with modifier 22, Increased Procedural Services, as it already includes the expected work for dealing with altered anatomy and scar tissue. However, if additional reconstruction of the abdominal wall is required, separate codes from the integumentary section of CPT should be used.

8. Historical information

CPT 44640 was added to the Current Procedural Terminology system on January 1, 1990. The only notable update to the code was its inclusion under the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A provider performs CPT 44640 to close off an intestinal cutaneous fistula in a patient who has not responded to nonsurgical therapy.
2. A patient with an enterocutaneous fistula undergoes CPT 44640, which includes resection and anastomosis if necessary.
3. A provider uses CPT 44640 to close an intestinal cutaneous fistula and performs additional reconstruction of the abdominal wall using separate codes from the integumentary section of CPT.
4. In a complex case, a provider performs CPT 44640 along with other procedures to address multiple intestinal cutaneous fistulas.
5. A patient with a persistent intestinal cutaneous fistula undergoes CPT 44640, which successfully closes off the abnormal passageway.
6. A provider performs CPT 44640 to treat an enterocutaneous fistula that has not improved with nonsurgical interventions.
7. In a challenging case, a provider performs CPT 44640 and utilizes a graft or flap for the closure of an intestinal cutaneous fistula.
8. A patient with a complicated intestinal cutaneous fistula undergoes CPT 44640, which involves resection and anastomosis to restore normal digestive function.
9. A provider performs CPT 44640 to close off an enterocutaneous fistula, ensuring the patient’s overall health and well-being.
10. In a successful procedure, a provider uses CPT 44640 to close an intestinal cutaneous fistula and achieves a positive outcome for the patient.