CPT 44139 Splenic Flexure Mobilization Reimbursement | OpenPayer

Summary & Overview

CPT 44139: Splenic Flexure Mobilization During Colectomy

CPT code 44139 designates an intraoperative add-on procedure for mobilization of the splenic flexure performed during the same session as a colectomy. This technical step is intended to prepare an adequate length of colon to permit safe partial resection and anastomosis. As an add-on code, 44139 is reported in conjunction with a primary colectomy code rather than as a standalone service. Nationally, accurate use of this code affects operative documentation, surgical quality reporting, and reimbursement for additional intraoperative work associated with complex colorectal resections.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, guidance on typical sites of service, expected billing classification as an add-on surgical code, and an overview of common modifiers and reporting considerations. The publication also summarizes benchmarks and policy implications where available and notes when input data are not present. This resource is intended for billing managers, surgical coders, and policy analysts seeking a clear, national-level reference for appropriate reporting of splenic flexure mobilization during colectomy.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare44139CPTcolectomysplenic flexure mobilizationsurgical-add-oncolorectal surgeryoperating roomambulatory surgery

Billing Code Overview

CPT code 44139 is an add-on surgical procedure reported when the provider mobilizes the splenic flexure during the same operative session in which a colectomy is performed. The maneuver prepares a suitable length of colon to facilitate partial resection and anastomosis.

Service type: Surgical — intraoperative add-on procedure

Typical site of service: Hospital operating room or ambulatory surgical center, reported only when performed in conjunction with a colectomy performed during the same session.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old male presenting with symptomatic sigmoid colon adenocarcinoma requiring elective partial colectomy. Preoperative evaluation includes colonoscopy with biopsy confirming malignancy, CT abdomen/pelvis staging, and clearance by anesthesia. In the operating room under general anesthesia, the colorectal surgeon performs a left-sided colectomy with removal of the involved segment. During the same session, the surgeon mobilizes the splenic flexure to gain additional colonic length for a tension-free anastomosis. Intraoperative steps include enteric mobilization of the transverse colon, division of adhesions near the spleen with preservation of splenic vessels as appropriate, assessment of perfusion to the bowel ends, and creation of an anastomosis or exteriorization as clinically indicated. Typical perioperative documentation captures indication, extent of mobilization, whether the procedure was open or laparoscopic, intraoperative findings, hemostasis, and any complications.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, and intensity substantially exceed typical colectomy with splenic flexure mobilization; documentation must justify the increased services.
`23`

CPT 44155: Proctocolectomy with End Ileostomy

CPT-44127-SMALL-BOWEL-RESECTION-ANASTOMOSIS-INTESTINAL-ATRESIA

CPT 44127: Small-Bowel Resection with Anastomosis for Intestinal Atresia

CPT-44133-LIVING-DONOR-INTESTINAL-HARVEST-WITH-ANASTOMOSIS

CPT 44133: Living-Donor Intestinal Harvest with Primary Anastomosis

CPT-44136-SMALL-BOWEL-RECONSTRUCTION-LIVING-DONOR-INTESTINE

CPT 44136: Small Bowel Reconstruction Using Living-Donor Intestine

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

CPT 44128: Small Bowel Resection and Anastomosis for Congenital Atresia

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

CPT 44156: Total Colectomy with Ileal Pouch Continent Ileostomy

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

CPT 44143: Colon Resection with End Colostomy

CPT-44145-PARTIAL-COLECTOMY-COLORECTAL-ANASTOMOSIS

CPT 44145: Partial Colectomy with Colorectal Anastomosis

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

CPT 44147: Colon Resection, Open Abdominal and Anal Approach

CPT-44144-COLON-RESECTION-WITH-COLOSTOMY-AND-MUCOUS-FISTULA

CPT 44144: Colon Resection with Colostomy and Mucous Fistula

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Taxonomy Code	Specialty	Notes
2080S0300X	Colorectal Surgery	Colorectal surgeons frequently perform colectomy with splenic flexure mobilization.
207K00000X	General Surgery	General surgeons commonly perform partial colectomies and associated mobilization.
208000000X	Surgical Oncology	Surgical oncologists manage oncologic colectomies requiring mobilization to achieve margins.
207L00000X	Minimally Invasive Surgery	Surgeons specializing in laparoscopic/robotic approaches perform mobilization laparoscopically.
363LF0000X	Thoracic Surgery	Included when complex thoracoabdominal resections require multidisciplinary involvement (less common).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C18.7`	Malignant neoplasm of sigmoid colon	Sigmoid colon cancer often requires partial colectomy with splenic flexure mobilization to achieve a tension-free anastomosis.
`C18.2`	Malignant neoplasm of ascending colon	Right-sided cancers may require mobilization in extended resections or when colon length is needed for reconstruction.
`K57.30`	Diverticulosis of large intestine without perforation or abscess	Complicated diverticular disease may necessitate segmental colectomy with mobilization for safe anastomosis.
`K35.80`	Unspecified acute appendicitis (with peritonitis)	When extensive inflammation or abscess involves the colon, mobilization may be required during colectomy.
`K63.5`	Polyp of colon	Large or unresectable polyps may lead to segmental colectomy with concomitant mobilization.
`K91.82`	Postprocedural intestinal ischemia	Ischemic segments may require resection; mobilization may be part of achieving viable margins.
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	In severe refractory inflammatory disease requiring resection, splenic flexure mobilization may be performed.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44140`	Colectomy, partial; with anastomosis (e.g., sigmoidectomy)	Primary colectomy codes are commonly performed with splenic flexure mobilization as an add-on when additional length is needed for an anastomosis.
`44204`	Laparoscopy, surgical; colectomy, partial, with anastomosis	Laparoscopic partial colectomy may include splenic flexure mobilization; the add-on `44139` documents the additional mobilization.
`44145`	Colectomy, partial; with colostomy or ileostomy	When diversion is required, the colectomy with splenic flexure mobilization may precede stoma formation.
`44120`	Enterectomy, resection of small intestine; single resection and anastomosis	Performed when concurrent small bowel resection is necessary during the same abdominal operation.
`44227`	Laparoscopy, surgical; abdominoperineal resection	In extended pelvic resections, splenic flexure mobilization may be needed to provide colon length for reconstruction.
`01960`	Anesthesia for intra-abdominal procedures	Anesthesia codes are billed by anesthesia providers for the surgical session during which splenic flexure mobilization occurs.

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