Summary & Overview
CPT 44128: Small Bowel Resection and Anastomosis for Congenital Atresia
CPT code 44128 covers surgical removal of an additional narrowed segment of the small intestine for congenital atresia with subsequent anastomosis of the remaining bowel. This operative code is clinically significant for neonatal and pediatric surgical care, as congenital intestinal atresia often requires timely resection and restoration of bowel continuity to prevent morbidity. Nationally, accurate coding for this procedure supports surgical quality measurement, appropriate payment for complex intra-abdominal operations, and tracking of pediatric surgical outcomes.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service and service line implications, common billing modifiers used with this code, and guidance on interpreting related claims fields. The publication summarizes benchmarks and coding practice considerations relevant to hospitals and surgical providers, highlights policy updates affecting hospital-based surgical reimbursement where available, and explains how this code fits within pediatric surgical service lines. Data not available in the input is indicated where applicable.
Billing Code Overview
CPT code 44128 describes a surgical procedure to remove an additional narrowed segment of the small intestine in a patient with congenital atresia, followed by creation of an anastomosis between the remaining intestinal loops. This procedure is classified as a small bowel resection with primary anastomosis performed for congenital intestinal obstruction.
-
Service type: Intra-abdominal surgical resection and anastomosis of the small intestine
-
Typical site of service: Hospital operating room, often performed by pediatric or general surgeons specializing in neonatal/infant abdominal surgery
Clinical & Coding Specifications
Clinical Context
A typical patient is a neonate or infant diagnosed with congenital small bowel atresia who presents with bilious vomiting, abdominal distension, and inability to tolerate enteral feeds. Prenatal ultrasound or postnatal radiographs suggest proximal intestinal obstruction; contrast study or abdominal radiography confirms transition point(s). The surgical team (pediatric general surgeon) performs exploratory laparotomy, identifies an additional narrowed segment of small intestine (residual or multiple atresias), resects the narrowed atretic segment, and creates a primary end-to-end or functional end-to-end anastomosis between the remaining viable intestinal loops to restore bowel continuity. Intraoperative considerations include assessment of bowel viability, length of remaining bowel to avoid short bowel syndrome, and parental counseling regarding postoperative neonatal intensive care, parenteral nutrition, and staged reoperations if needed. Typical site of service is an inpatient operating room within a tertiary pediatric hospital. The service type is operative surgical repair (open bowel resection with anastomosis) for congenital intestinal atresia under general anesthesia with perioperative neonatal critical care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — default | Use when no special modifier applies and standard reporting is appropriate |