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    v1.0.31
    OpenPayerBilling CodesExcision Procedures on the Intestines (Except Rectum)CPT cpt-44146-low-anterior-resection-with-colostomy
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    CPT 44146: Low Anterior Resection with Colostomy

    Medicare pays $1960 on average nationally for this procedure.

    CPT code 44146 describes a low anterior resection with colorectal anastomosis and creation of a colostomy to remove a diseased portion of the colon and restore bowel continuity low in the pelvis; service type: major abdominal colorectal surgery; typical site of service: inpatient operating room during a hospital stay.

    For related coverage guidance, see recent payer policy updates: Achalasia and Gastroesophageal Reflux Disease (GERD) - Minimally Invasive Procedures - Medical Policy, Esophageal Brush Biopsy, Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders.

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    Table of contents

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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44145Colectomy, partial; with colostomyPerformed for resections of more proximal colon segments when a colostomy is required; may be used if resection extent differs from 44146
    44150Colectomy, partial; with anastomosisAlternative when an anastomosis is performed without creation of a colostomy; may be used for higher colorectal anastomoses
    44320Colostomy; temporaryCoding for creation of a temporary colostomy stoma; may be reported if ostomy creation is a separate documented component
    44160Colectomy, total; intra-abdominal, without proctectomyPerformed when more extensive colonic resection is required beyond the sigmoid/rectal segment
    43760Colostomy revisionReported for subsequent procedures to revise or mature a stoma created during 44146

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RC0000X
    208800000X
    207L00000X
    207K00000X
    261QD1600X
    209800000X
    282NC2000X
    152W00000X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    C18.7Malignant neoplasm of sigmoid colon
    C19Malignant neoplasm of rectosigmoid junction
    C20Malignant neoplasm of rectum
    C21.8Malignant neoplasm of overlapping sites of rectum, anus and anal canal
    C49.4Malignant neoplasm of connective and soft tissue of abdomen
    E87.4Mixed disorder of acid-base balance
    I83.10Varicose veins of unspecified lower extremity with inflammation
    I85.00Esophageal varices without bleeding
    K50.912Crohn's disease, unspecified, with intestinal obstruction

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 4

    10 rows

    PolicyPayerEffective Date
    Achalasia and Gastroesophageal Reflux Disease (GERD) - Minimally Invasive Procedures - Medical PolicyHealth-New-England2027-02-01
    Esophageal Brush Biopsycaresourcegeorgia2026-12-01
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Gastric Pacing/Gastric Electrical Stimulation (GES)Cigna2026-11-15
    Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interactionpremerabluecrossofwashington2026-11-06
    Percutaneous electrical nerve field stimulation for disorders of gut-brain interactionpremerabluecrossofwashington2026-11-06
    Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interactionpremerabluecrossofwashington2026-11-06
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Non-invasive Testing for Liver FibrosisModa Health2026-11-01
    Surgical Site of Care - Colonoscopy and Sigmoidoscopyregence2026-11-01

    Related Codes

    CPT-44100-SMALL-INTESTINE-CAPSULE-BIOPSY

    CPT 44100: Small Intestine Biopsy via Oral Capsule

    CPT-44110-OPEN-EXCISION-INTESTINAL-LESION-SINGLE-INCISION

    CPT 44110: Excision of Lesion(s) From Small or Large Intestine

    CPT-44111-INTESTINAL-LESION-EXCISION-MULTIPLE-INCISIONS

    CPT 44111: Excision of Intestinal Lesions via Multiple Incisions

    CPT-44120-SMALL-INTESTINE-RESECTION-PRIMARY-ANASTOMOSIS

    CPT 44120: Small Bowel Resection with Primary Anastomosis

    CPT-44121-ADDITIONAL-SMALL-INTESTINE-RESECTION-ANASTOMOSIS

    CPT 44121: Additional Small Intestine Resection and Anastomosis

    CPT-44125-SMALL-INTESTINE-RESECTION-WITH-STOMA-CREATION

    CPT 44125: Small Bowel Resection with Enterostomy

    CPT-44126-SMALL-BOWEL-RESECTION-CONGENITAL-ATRESIA-END-TO-END-ANASTOMOSIS

    CPT 44126: Small Bowel Resection for Intestinal Atresia with Anastomosis

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

    CPT 44127: Resection and Anastomosis for Congenital Small-Bowel Atresia

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

    CPT 44128: Resection of Small Intestine for Congenital Atresia

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

    CPT 44130: Intestinal Anastomosis, With or Without Stoma

    Showing 1–10 of 29

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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