Summary & Overview
CPT 44146: Low Anterior Resection with Colostomy
CPT code 44146 represents a major colorectal surgical procedure: low anterior resection with a low pelvic anastomosis and creation of a colostomy. This code is used for inpatient operative reporting when a diseased segment of colon is removed and continuity is restored low in the pelvis while a stoma is formed. Nationally, procedures of this complexity have significant implications for hospital resource use, postoperative care pathways, and payer coverage policies.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a succinct overview of clinical context, typical sites of service, common billing considerations, and the types of benchmarks and policy issues that affect coverage and payment for complex colorectal surgery. The publication outlines reimbursement and utilization benchmarks, common modifier usage patterns, and policy updates that influence authorization and postoperative care requirements. Clinical context covers indications for resection and colostomy formation, perioperative care implications, and expected inpatient care pathways. Data not available in the input is clearly noted when specific benchmarks, associated taxonomies, ICD-10 diagnoses, or related codes are not provided.
Billing Code Overview
CPT code 44146 describes a surgical procedure in which the surgeon performs a low anterior resection of the rectum with colorectal or coloanal anastomosis and concurrently creates a colostomy. The operation involves an abdominal incision to remove the diseased segment of the colon and constructs an anastomosis low in the pelvis, followed by formation of a stoma that diverts fecal stream through the abdominal wall.
-
Service type: Major abdominal colorectal surgery involving resection, low pelvic anastomosis, and colostomy creation
-
Typical site of service: Inpatient hospital operating room with postoperative inpatient recovery
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a distal sigmoid colon adenocarcinoma presents with obstructive symptoms, including abdominal pain, distention, and altered bowel habits. Imaging and colonoscopy confirm a tumor in the distal sigmoid approaching the rectosigmoid junction with partial obstruction and concern for local inflammation. The surgical team plans a low anterior resection with removal of the affected colon segment, a low colorectal anastomosis performed deep in the pelvis, and creation of a colostomy (end or loop) to divert fecal stream and protect the anastomosis.
Preoperative workflow includes history and physical, staging with CT chest/abdomen/pelvis, bowel preparation as indicated, informed consent documenting the planned low anterior resection with colostomy, and anesthesia evaluation. Intraoperative care includes abdominal incision, mobilization of the sigmoid and rectum, resection of the diseased segment, creation of a low pelvic colorectal anastomosis, and formation of a colostomy. Postoperative workflow includes monitoring in PACU, inpatient surgical rounds, ostomy teaching by a wound/ostomy nurse, pathology review of the resected specimen, and discharge planning with outpatient follow-up for stoma care and consideration of adjuvant therapy if malignancy is confirmed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / default indicator | Rarely appended; indicates standard procedure when systems require a two-character modifier placeholder |