CPT 44121: Additional Small Intestine Resection with Anastomosis - OpenPayer

Summary & Overview

CPT 44121: Additional Small Intestine Resection with Anastomosis

CPT code 44121 identifies an intraoperative extension to an initial small intestine resection: resection of one or more additional affected segments with subsequent anastomosis performed during the same operative session. This code captures additional operative work when a surgeon removes further diseased small bowel segments beyond the planned resection and restores bowel continuity. Nationally, accurate use of this code matters for clinical documentation, operative reporting, and consistent payment for additional intraoperative procedures.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise overview of the clinical context for using 44121, typical sites of service, and which payers are commonly considered in coverage and reimbursement discussions. The publication summarizes benchmarks and policy-relevant points such as documentation expectations, coding context relative to primary small intestine resection and anastomosis, and common modifiers encountered in practice. It also outlines what to look for in operative reports to support use of this code and highlights areas where payers commonly review claims for medical necessity. This executive summary provides clinicians, coding professionals, and policy analysts a practical, national-level reference for understanding the role and implications of CPT code 44121 in surgical billing and reporting.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare44121CPTsmall intestine resectionanastomosissurgical codingabdominal surgeryoperative reportintraoperative

Billing Code Overview

CPT code 44121 describes resection of one or more additional affected segments of the small intestine performed at the same session as the initial small intestine resection and anastomosis, followed by reconnection (anastomosis) of the remaining intestinal ends. This procedure represents an intraoperative extension of an initial small bowel resection to remove additional diseased or damaged segments.

Service type: Surgical procedure — additional small intestine resection with anastomosis performed during the same operative session as the initial small intestine resection and anastomosis.
Typical site of service: Hospital operating room or other inpatient/ambulatory surgical settings where major abdominal surgery is performed.

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a history of Crohn disease presents with progressive abdominal pain, low-grade fever, and obstructive symptoms. Imaging (CT abdomen/pelvis) demonstrates two noncontiguous strictured segments of mid and distal ileum with proximal dilation and focal inflammatory change. After resuscitation and appropriate preoperative evaluation, the patient is taken to the operating room for an exploratory laparotomy. The surgeon performs an initial small intestine resection and primary anastomosis for the most diseased segment. During the same operative session the surgeon identifies an additional affected segment of small intestine that is ischemic and nonviable; the surgeon resects this additional segment and creates a single primary anastomosis connecting the remaining intestinal ends. Intraoperative findings, procedure notes, and pathology specimens document the two separate resections performed at the same session.

Typical workflow steps:

Preoperative evaluation, informed consent, and documentation of indications (e.g., obstructive Crohn disease, ischemia, tumor).
Intraoperative exploration and determination of segments requiring resection.
Performance of the initial small intestine resection with anastomosis.
Performance of one or more additional small intestine resections during the same session followed by reconstruction/anastomosis of the remaining bowel.
Operative report clearly describing number of resections, locations, lengths of bowel removed, type of anastomosis, and any complications.
Post-anesthesia and postoperative documentation, pathology correlation, and coding to reflect the additional resections performed at the same session using 44121 when applicable.

CPT 44111: Excision of Intestinal Lesions, Multiple Incisions

CPT-44155-PROCTOCOLECTOMY-WITH-END-ILEOSTOMY

CPT 44155: Proctocolectomy with End Ileostomy

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

CPT 44128: Small Bowel Resection and Anastomosis for Congenital Atresia

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

CPT 44143: Colon Resection with End Colostomy

CPT-44130-INTESTINAL-ANASTOMOSIS-BOWEL-RESECTION-ANASTOMOSIS

CPT 44130: Intestinal Anastomosis, With or Without Stoma

CPT-44156-CONTINENT-ILEOSTOMY-WITH-ILEAL-POUCH

CPT 44156: Total Colectomy with Ileal Pouch Continent Ileostomy

CPT-44146-LOW-ANTERIOR-RESECTION-WITH-COLOSTOMY

CPT 44146: Low Anterior Resection with Colostomy

CPT-44137-SMALL-INTESTINE-GRAFT-EXPLANTATION

CPT 44137: Small Intestine Graft Explantation

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

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

CPT-44147-COLON-RESECTION-OPEN-ABDOMINAL-AND-ANAL-APPROACH

CPT 44147: Colon Resection, Open Abdominal and Anal Approach

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Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services required substantially greater effort or complexity than typical for `44121` and documentation supports increased work.
`52`	Reduced services	Use when the planned additional resection/anastomosis was partially performed or reduced in scope compared to the full procedure.
`53`	Discontinued procedure	Use when the additional resection was started but aborted due to patient instability or unforeseen circumstance.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure when bundling edits might obscure that an additional resection was performed at a different site or session component.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing portions of the resection/anastomosis.
`63`	Procedure performed on infants less than 4 kg	Use when `44121` is performed on a neonate/infant meeting weight criteria.
`78`	Unplanned return to the operating room for a related procedure by the same physician	Use when an additional resection/anastomosis is performed in a separate, unplanned reoperation related to the original procedure.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an additional procedure performed in the global period is unrelated to the original small intestine resection (note: `79` is not listed in input modifiers; use `59` or other appropriate modifier from the provided list).
`76`	Repeat procedure by same physician	Not in provided list; do not use.
`51`	Multiple procedures	Not in provided list; do not use.
`54`	Surgical care only	Use when the billing covers only the surgeon’s intraoperative services for `44121` and another practitioner bills pre/postoperative care.
`55`	Postoperative management only	Use when billing is limited to postoperative care for the procedure.
`26`	Professional component	Use when a professional interpretation component exists; rarely applicable for pure operative CPTs but may apply to intraoperative consults.
`59`	Distinct procedural service	(Duplicate row omitted elsewhere)

Taxonomy Code	Specialty	Notes
Data not available in the input.	Data not available in the input.	Data not available in the input.
`207L00000X`	General Surgery	General surgeons most commonly perform small intestine resections and anastomoses.
`207LH0000X`	Colon & Rectal Surgery	Colorectal surgeons perform resections when disease involves distal small bowel and ileocecal region.
`207LE0101X`	Pediatric Surgery	Pediatric surgeons perform small bowel resections in infants/children.
`207LP2900X`	Surgical Oncology	Surgical oncologists perform resections when malignancy is the indication.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K50.012`	Crohn disease of small intestine with intestinal obstruction	Crohn disease strictures are a common indication for multiple small bowel resections and anastomosis during the same session.
`K55.0`	Acute vascular disorder of intestine	Segmental ischemia can require resection of multiple affected small bowel segments.
`K56.69`	Other intestinal obstruction	Obstruction from adhesions or strictures may necessitate resection of more than one segment.
`K57.50`	Diverticulitis of small intestine with perforation and abscess	Complicated diverticulitis or perforation can require multiple resections and repair.
`C17.9`	Malignant neoplasm of small intestine, unspecified	Multifocal or locally advanced tumors may require additional segmental resections in the same session.
`K63.1`	Perforation of intestine (nontraumatic)	Perforation with contamination can lead to multiple resections of compromised segments.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Resection of small intestine; single resection and anastomosis	Often coded for the initial single small intestine resection and anastomosis; `44121` is used when one or more additional segments are resected at the same session.
`44202`	Laparoscopy, surgical; colectomy, partial, with anastomosis	May be performed in the same operative episode if colonic disease is addressed laparoscopically in conjunction with small bowel resections.
`44204`	Laparoscopy, surgical; colectomy, partial, with anastomosis, for diverticulitis or other disease	Related when combined colonic and small bowel disease are managed in same operative setting.
`44125`	Enterectomy, resection of small intestine with end-to-end anastomosis, multiple resections	Used when coding multiple discrete small intestine resections in some coding conventions; verify payer guidance relative to `44121`.
`49560`	Incision and drainage, incarcerated or strangulated hernia, with resection of small intestine	Performed when bowel resection is required emergently for strangulated hernia in the same operative episode.

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