Summary & Overview
CPT 44133: Living-Donor Intestinal Harvest with Primary Anastomosis
CPT code 44133 represents a complex abdominal surgical service in which a living donor provides a segment of intestine; the donor’s remaining bowel is reconnected by primary anastomosis and the harvested segment is cold-preserved. This code is clinically significant for transplant and complex reconstructive care pathways and has implications for surgical teams, hospital perioperative capacity, and payer coverage policies. Key payers reviewed in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service and typical sites of care, the common modifier set used alongside the code, and what is known about payer coverage patterns and billing considerations. The publication also summarizes benchmarking and policy-relevant issues that affect reimbursement and utilization for intestinal harvest procedures, highlights clinical context such as transplant and intestinal failure management, and identifies gaps where standard coding guidance or payer policy language is sparse. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 44133 describes a surgical procedure in which a segment of intestine is harvested from a living donor and the two remaining intestinal ends are surgically anastomosed (stitched) together. The code explicitly includes cold preservation of the donor intestinal segment as part of the billed service.
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Service type: Living-donor intestinal segment harvest with primary intestinal anastomosis; includes cold preservation of the donor intestine.
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Typical site of service: Hospital operating room or ambulatory surgical center configured for major abdominal surgery.
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 32-year-old living donor is evaluated and selected to donate a segment of small intestine for a pediatric recipient with short bowel syndrome. Preoperative evaluation includes surgical clearance, infectious disease testing, blood type and HLA crossmatch coordination with the transplant team, and informed consent discussing risks of bowel resection and anastomotic leak. On the day of surgery the donor is brought to an operating room at an acute care hospital or transplant center. Anesthesia induction is followed by a midline laparotomy or minimally invasive approach to mobilize the intended intestinal segment. The surgeon resects the donor segment and performs an immediate primary intestinal anastomosis to restore continuity of the donor bowel. The harvested segment is flushed, placed in cold preservation solution, and transferred to the transplant team for implantation into the recipient. Postoperative workflow includes donor recovery monitoring for bowel function, pain control, infection surveillance, and discharge planning with instructions for activity and diet advancement. Typical site of service is an inpatient acute care hospital or specialized transplant center. Service type is an open or laparoscopic surgical harvest of a living donor intestinal segment with primary anastomosis and cold preservation of the graft.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier reported | Use when no modifier is required or applicable for the service. |
22 | Increased procedural services | Use when work required is substantially greater than typical (unusual donor anatomy, extensive adhesiolysis). |
26 | Professional component | Rarely applicable for this major surgical procedure; not typically used for operative surgical services. |
50 | Bilateral procedure | Use if bilateral organ/panel procedures are reported and payer requires bilateral reporting (uncommon for intestinal harvest). |
51 | Multiple procedures | Use when additional unrelated surgical procedures are performed during the same operative session. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as typically described. |
53 | Discontinued procedure | Use if the procedure is terminated after anesthesia due to medical reasons before completion. |
54 | Surgical care only | Use when reporting only the surgical portion and another physician provides pre/postoperative care. |
55 | Postoperative management only | Use when reporting only postoperative care (e.g., another surgeon performed the operation). |
62 | Two surgeons | Use when two surgeons of different specialties participate and both perform distinct portions of the operation. |
66 | Surgical team (multiple surgeons) | Use for complex donor operations requiring a documented surgical team billing arrangement. |
78 | Return to OR for a related procedure during the postoperative period | Use if the donor returns to the operating room for a complication related to the initial harvest. |
80 | Assistant surgeon | Use when an assistant surgeon provides intraoperative assistance and payer requires modifier reporting. |
81 | Minimum assistant surgeon | Use when only minimal assistance is provided and payer recognizes reduced assistant billing. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207LH0002X | General Surgery | General surgeons with transplant experience commonly perform donor bowel resections and anastomoses. |
| 207L00000X | Transplant Surgery | Transplant surgeons coordinate donor harvest and graft preservation for intestinal transplantation. |
| 207K00000X | Colorectal Surgery | Colorectal surgeons may be involved in complex bowel mobilization and reconstruction. |
| 2080P0207X | Pediatric Surgery | Pediatric surgeons participate when donor or recipient care involves pediatric patients. |
| 207X00000X | Surgical Critical Care | Critical care surgeons manage perioperative complexity in high-risk donors and coordinate ICU care. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K91.89 | Other postprocedural complications and disorders of digestive system | Relevant for postoperative donor complications monitoring (anastomotic leak, ileus). |
K91.83 | Postprocedural septicemia | Relevant if donor develops systemic infection after harvest. |
Z48.815 | Encounter for surgical aftercare following surgery on the digestive system | Used for postoperative follow-up visits for the donor. |
Z52.8 | Other organ or tissue donor | Indicates living donor status in the medical record. |
T81.31XA | Disruption of operation (mechanical) — initial encounter | Relevant if there is an intraoperative complication affecting the donor anastomosis or harvest. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
44120 | Enterectomy, resection of small intestine; single resection and anastomosis | An alternative code for non-donor small bowel resections; used when enterectomy is performed for donor but without transplant-specific preservation elements. |
47135 | Donor hepatectomy, living donor, lobe or segment | Related living donor organ harvest code illustrating parallel workflow components (donor evaluation, resection, preservation) though for liver. |
0196T | Donation of intestinal segment, living donor (harvest and transfer) — Category III example code (if applicable by payer) | Some payers may track living-donor organ procurement with procedure-specific tracking codes; used alongside donor harvest documentation when available. |
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