CPT 44055 Derotation/Lysis Reimbursement | OpenPayer

Summary & Overview

CPT 44055: Open Surgical Derotation and Lysis of Intestinal Malrotation

CPT code 44055 represents an open surgical procedure to correct intestinal malrotation by derotation or reduction of volvulus and by division of bands that obstruct the duodenum. This operative code is clinically significant because intestinal malrotation and volvulus are potentially life‑threatening conditions requiring timely surgical management; accurate coding influences surgical case reporting, hospital resource use classification, and national procedure statistics. Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise presentation of what the code covers clinically and operationally, payer coverage considerations, and common billing contexts. The publication outlines typical sites of service and service type, summarizes common modifiers used with this code when available, and highlights areas where policy updates or billing clarifications frequently occur. It also provides benchmarking context and comparator codes where relevant. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare44055CPTintestinal-malrotationsurgerylysis-of-bandsderotationgeneral-surgeryoperating-roominpatient-surgery

Billing Code Overview

CPT code 44055 describes a surgical procedure in which the surgeon makes an incision to access part of the intestine (excluding the rectum) and relieves intestinal malrotation. The operation involves reducing volvulus or derotating the malrotated bowel and may include division or lysis of peritoneal bands that kink the duodenum.

Service type: Open surgical correction of intestinal malrotation (lysis of Ladd bands and derotation/reduction)
Typical site of service: Inpatient or outpatient surgical setting, most commonly performed in an operating room under general anesthesia

Clinical & Coding Specifications

Clinical Context

A typical patient is a child or young adult presenting with recurrent, intermittent abdominal pain, bilious vomiting, failure to thrive, or acute intestinal obstruction. Physical exam may show abdominal distention and tenderness; imaging (upper GI series or CT) demonstrates malrotation with volvulus or obstruction of the duodenum. The operative workflow includes preoperative resuscitation and diagnostics, induction of general anesthesia, a midline or right upper quadrant laparotomy (or laparoscopic approach when appropriate), exploration of the small intestine, lysis or division of Ladd bands, counterclockwise derotation of volvulus if present, widening of the mesenteric base, and placement of the small bowel on the right and colon on the left. Intraoperative decisions include assessment of bowel viability and possible resection if necrosis is identified. Postoperative care includes monitoring for return of bowel function, pain control, and gradual advancement of diet. Typical site of service is an inpatient hospital operating room; ambulatory surgical centers are less common but may be used for stable, elective cases without anticipated bowel resection.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or time is substantially greater than typical for the procedure (extensive adhesiolysis, prolonged derotation, complex resection and anastomosis).

CPT 44020: Gastrointestinal Surgical Procedure

CPT-44010-EXPLORATORY-ABDOMEN-DUODENUM-EXCISION-BIOPSY-FOREIGN-BODY

CPT 44010: Exploratory Abdominal Surgery with Duodenal Examination

CPT-44050-OPEN-INTESTINAL-REPAIR-TWISTED-TELESCOPED-HERNIATED-BOWEL

CPT 44050: Open Intestinal Repair for Twisted, Telescoped, or Herniated Bowel

CPT-44005-LYSIS-OF-ADHESIONS-COLON-ABDOMINAL-ADHESIOLYSIS

CPT 44005: Lysis of Adhesions, Colon and Intra‑abdominal Structures

CPT-44015-JEJUNOSTOMY-FEEDING-TUBE-PLACEMENT

CPT 44015: Jejunostomy Feeding Tube Placement

CPT-44021-SMALL-BOWEL-EXPLORATION-DECOMPRESSION

CPT 44021: Small Bowel Exploration and Decompression Procedure

CPT-44025-COLON-INCISION-EXAMINATION-BIOPSY-REMOVAL-FOREIGN-BODY

CPT 44025: Incision of Colon for Examination, Biopsy, or Foreign Body Removal

Taxonomy Code	Specialty	Notes
`207SF0200X`	Pediatric Surgery	Frequently performs Ladd procedure and management of malrotation in infants and children.
`207XS0121X`	General Surgery	Performs Ladd procedure in adolescents and adults; manages intra-abdominal adhesiolysis and resections.
`207K00000X`	Colon and Rectal Surgery	May be involved if colonic anatomic repositioning or resection is required.
`2080S0115X`	Acute Care Surgery	Manages emergency presentations with volvulus and ischemic bowel requiring urgent operative care.
`2086S0120X`	Pediatric Critical Care Medicine	Provides perioperative critical care for unstable pediatric patients (consult role).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q43.3`	Malrotation of intestine	Primary diagnosis indicating congenital intestinal malrotation requiring surgical correction such as a Ladd procedure (`44055`).
`K56.2`	Volvulus	Represents twisting of the intestine that may accompany malrotation and necessitate urgent derotation and possible resection.
`K56.1`	Intussusception	May present similarly with obstruction requiring operative intervention; differentiation and management occur intraoperatively.
`K91.89`	Other postprocedural complications and disorders of digestive system	Used for documenting postoperative complications related to intestinal surgery when appropriate.
`K55.0`	Acute vascular disorders of intestine (ischemia)	Relevant when bowel ischemia from volvulus is present and prompts resection during the procedure.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Enterolysis (separate procedure); adhesiolysis of small intestine	Performed when dense adhesions require lysis separate from the primary derotation/lysis of bands.
`44140`	Colectomy, partial; resection of large intestine with anastomosis	May be required if compromised colon necessitates resection during exploration for malrotation complications.
`44121`	Enterolysis (separate procedure); adhesiolysis with small bowel resection	Used when nonviable small bowel is identified and resected in the same operative setting.
`44204`	Laparoscopy, surgical; small intestine, enterolysis	Laparoscopic approach options for lysis of adhesions and correction of malrotation when minimally invasive technique is used.
`44125`	Enterectomy, resection of small intestine with primary anastomosis	Performed when segments of small bowel are necrotic from volvulus and require resection and anastomosis.

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