CPT 44120 Small Intestine Resection Reimbursement | OpenPayer

Summary & Overview

CPT 44120: Small Intestine Resection with Primary Anastomosis

CPT code 44120 represents a surgical small intestine resection with primary anastomosis — removal of a single diseased segment of small bowel and reconnection of the remaining ends. This operation is a core inpatient general surgery procedure with implications for surgical quality measurement, hospital resource use, and payer coverage determinations nationwide. It matters clinically because outcomes depend on timely intervention, surgical technique, and postoperative management, and it matters financially because it typically drives inpatient surgical reimbursement and utilization patterns.

Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the procedure, expected site-of-service and service type, and the common modifiers associated with billing in this clinical context. The publication also summarizes benchmarks and programmatic issues relevant to this code — including payment considerations for inpatient surgical services, utilization trends for intestinal resections, and policy updates affecting surgical billing and inpatient coverage. Where specific data elements are not supplied in the input, the text notes that those details are not available in the input. The coverage is written for a national audience seeking clinical, coding, and payer-context clarity for CPT code 44120.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 44120small bowel resectionintestinal anastomosisgeneral surgeryinpatient surgerysurgical procedure billinghospital operating roomprocedure coding

Billing Code Overview

CPT code 44120 describes a surgical procedure in which a single affected segment of the small intestine (small bowel) is removed and the remaining intestinal ends are reconnected (an intestinal resection with primary anastomosis). This procedure is performed to treat localized pathology of the small intestine such as obstruction, ischemia, perforation, tumors, or severe inflammatory disease.

Service type: Surgical resection of small intestine with primary anastomosis
Typical site of service: Hospital operating room or inpatient surgical setting

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old male presenting to the emergency department with progressive abdominal pain, distention, vomiting, and failure to pass flatus for 48 hours. Imaging (CT abdomen/pelvis) demonstrates a single-segment small bowel obstruction with a strangulated loop and segmental ischemia. After resuscitation, informed consent, and preoperative clearance, the patient is taken to the operating room for an exploratory laparotomy. The surgeon identifies a single necrotic segment of small intestine (ileum) approximately 20 cm in length; the affected segment is resected and a primary end-to-end small bowel anastomosis is performed. Postoperative workflow includes transfer to a monitored bed, serial abdominal examinations, pain control, venous thromboembolism prophylaxis, monitoring for anastomotic leak, advancing diet as tolerated, and discharge planning with outpatient surgical follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier specified on some insurer lists (placeholder)	Rarely used; follow payer-specific rules when no other modifier applies.
`22`	Increased procedural services	Use when the resection and anastomosis required substantially greater work than typical (extensive adhesiolysis, hostile abdomen).

CPT 44151: Total Colectomy with Ileal Pouch and Continent Ileostomy

CPT-44139-SPLENIC-FLEXURE-MOBILIZATION-DURING-COLECTOMY

CPT 44139: Splenic Flexure Mobilization During Colectomy

CPT-44141-COLON-RESECTION-WITH-CECOSTOMY-OR-COLOSTOMY

CPT 44141: Colon Resection with Skin-Level Cecostomy or Colostomy

CPT-44157-TOTAL-PROCTOCOLECTOMY-ILEOANAL-ANASTOMOSIS

CPT 44157: Total Proctocolectomy with Ileoanal Anastomosis

CPT-44110-OPEN-EXCISION-INTESTINAL-LESION-SINGLE-INCISION

CPT 44110: Open Excision of Intestinal Lesion(s), Single Incision

CPT-44132-DONOR-SMALL-BOWEL-RESECTION-PRESERVATION-FOR-TRANSPLANT

CPT 44132: Donor Small Intestine Resection and Cold Preservation

CPT-44143-COLON-RESECTION-WITH-END-COLOSTOMY

CPT 44143: Colon Resection with End Colostomy

CPT-44128-SMALL-BOWEL-RESECTION-ANASTOMOSIS-CONGENITAL-ATRESIA

CPT 44128: Small Bowel Resection and Anastomosis for Congenital Atresia

CPT-44135-SMALL-BOWEL-TRANSPLANT-WITH-CADAVER-INTESTINE-RECONSTRUCTION

CPT 44135: Small Bowel Transplant with Cadaver Donor Intestine

CPT-44126-SMALL-BOWEL-RESECTION-CONGENITAL-ATRESIA-END-TO-END-ANASTOMOSIS

CPT 44126: Small Bowel Resection for Congenital Atresia with End-to-End Anastomosis

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Taxonomy Code	Specialty	Notes
2080S00000X	General Surgery	Most common specialty performing small bowel resection and anastomosis.
2086S0120X	Colorectal Surgery	Performs resections when disease involves distal small bowel near ileocecal valve or complex resections.
207L00000X	Surgical Critical Care	Manages critically ill patients pre- and postoperatively; may assist intraoperatively in complex cases.
207K00000X	Acute Care Surgery	Frequently provides emergency operative management for small bowel obstruction and strangulation.
2084S0112X	Pediatric Surgery	Performs small bowel resections in pediatric patients when applicable.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K56.60`	Unspecified intestinal obstruction	Common indication for small bowel resection when obstruction is present and nonresponsive to conservative management.
`K56.69`	Other intestinal obstruction	Used when obstruction is specified to be due to causes not captured elsewhere; relevant for operative management.
`K55.0`	Acute vascular disorders of intestine	Mesenteric ischemia leading to segmental bowel necrosis requiring resection.
`K57.20`	Diverticulitis of small intestine with perforation and abscess	Small bowel diverticular disease with complication may necessitate resection.
`K63.1`	Perforation of intestine (nontraumatic)	Free perforation with localized or generalized peritonitis frequently requires resection of affected segment.
`C78.7`	Secondary malignant neoplasm of small intestine	Metastatic lesion requiring segmental resection for symptom control or palliation.
`K50.019`	Crohn's disease of small intestine with obstruction	Crohn disease causing stricturing or obstructive segments commonly treated with segmental resection and anastomosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Enterectomy, resection of small intestine; single resection and anastomosis	Primary procedure described.
`49000`	Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)	Often performed immediately before definitive resection to identify the pathology and assess bowel viability.
`44125`	Enterectomy, resection of small intestine, with small bowel anastomosis, multiple segments	Used when more than one separate bowel segment is resected during the same operative session.
`44625`	Resection of small intestine with anastomosis (radical), for specific extensive resections	Used for more extensive or radical small bowel resections when indicated by disease extent (select per payer/editorial guidance).
`44130`	Enterolysis (lysis of adhesions) of small intestine	Often performed concomitantly if adhesions are the cause of obstruction and require release to free bowel prior to resection.
`44204`	Laparoscopy, surgical; enterolysis, small intestine	Minimally invasive approach codes may be used when the procedure or adhesiolysis is performed laparoscopically prior to or instead of open resection.

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