Summary & Overview

CPT 44147: Colon Resection, Open Abdominal and Anal Approach

CPT code 44147 denotes a combined open abdominal and anal colon resection with reconnection (anastomosis) of the remaining colon. This major surgical code is used for colorectal resections that require both a laparotomy and transanal access and is relevant to hospitals, surgical departments, and payers nationally due to its implications for inpatient resource use, postoperative care, and bundled payment arrangements. Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common billing modifiers, and which payers commonly cover or adjudicate claims for this service. The publication summarizes national benchmarks and utilization patterns where available, highlights recent policy or coding guidance that affects documentation and claim submission, and outlines typical billing considerations for surgical services of this complexity. Data not available in the input is noted where applicable; the focus remains on explaining the code’s clinical meaning, typical care setting, and the payer landscape readers should consider when preparing claims or reviewing coverage policies.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare44147CPTcolon resectioncolorectal surgeryanastomosisinpatient surgerysurgical billingoperative procedureabdominal surgery

Billing Code Overview

CPT code 44147 describes a surgical procedure in which the surgeon removes the affected portion of the colon using a combined open abdominal and anal approach and reconnects the remaining ends of the colon. This procedure is a form of colon resection with an abdominal and perineal/anal approach performed through a laparotomy (open abdominal incision) and transanal access.

Service type: Major abdominal and colorectal surgery involving combined open abdominal and anal approaches for resection and anastomosis of the colon.
Typical site of service: Hospital inpatient or operating room for major surgical procedures, including facilities equipped for colorectal surgery and postoperative inpatient care.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55–75-year-old adult presenting with symptomatic left-sided colonic disease such as obstructive diverticulitis with stricture, recurrent segmental ischemia, or localized neoplasm not amenable to limited colectomy. The patient has progressive abdominal pain, change in bowel habits, and imaging (CT abdomen/pelvis) demonstrating a diseased segment of colon requiring resection. Preoperative evaluation includes history and physical, colonoscopy or CT colonography as indicated, labs, anesthesiology assessment, and informed consent for an open abdominal and transanal approach. In the operating room under general anesthesia, the surgical team makes an abdominal incision to mobilize the colon, performs proximal and distal mobilization through combined abdominal and anal exposures, resects the affected segment, and performs a primary anastomosis connecting the cut ends of colon. Postoperative workflow includes pain control, early ambulation, bowel function monitoring, wound care, and discharge planning with follow-up for wound check and assessment of bowel continuity and function.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Use when no specific modifier applies and billing requires the default two-digit modifier field populated.
`11`	Physician or Other Qualified Health Care Professional Service	Use to indicate the usual, scheduled service by the reporting clinician.
`22`	Increased Procedural Services	Use when work or time significantly exceeds the typical service for `44147` (document justification).
`23`	Unusual Anesthesia	Use when general anesthesia is not administered due to unusual circumstances making anesthesia medically contraindicated or not used.
`52`	Reduced Services	Use if procedure is partially reduced or not completed as originally planned.
`53`	Discontinued Procedure	Use when `44147` is started but discontinued due to extenuating circumstances or patient instability.
`62`	Two Surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of `44147`.
`66`	Surgical Team	Use when a surgical team (more than two surgeons) is necessary for the patient’s care during `44147`.
`80`	Assistant Surgeon	Use when an assistant surgeon provides assistance during the operation.
`81`	Minimum Assistant Surgeon	Use when a minimal assistant provides limited assistance.
`82`	Assistant Surgeon (When Qualified Resident Not Available)	Use when an assistant is needed and a qualified resident is not available.
`52`	Reduced Services	Use when the resection/anastomosis is performed in a limited fashion compared with full procedure.
`53`	Discontinued Procedure	Use when procedure attempted but stopped before completion for clinical reasons.
`63`	Procedure Performed on Infants Less Than 4 kg	Rarely applicable; use only when patient weight criteria are met.

Taxonomy Code	Specialty	Notes
208800000X	Colon and Rectal Surgery	Primary specialty most commonly performing `44147`.
207P00000X	General Surgery	Frequently performs open colectomies with transanal components.
208600000X	Surgical Oncology	Performs resections when malignancy is the indication.
208D00000X	Critical Care Medicine	Provides perioperative critical care for high-risk patients.
207L00000X	Gastroenterology	Involved in preoperative diagnostics and postoperative endoscopic evaluation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K57.32`	Diverticulitis of large intestine with perforation and abscess, segmental	Segmental diverticulitis causing localized sepsis or abscess may require segmental resection and anastomosis via combined approaches.
`K63.5`	Polyp of colon	Large or complex polyps not amenable to endoscopic removal may necessitate segmental colectomy.
`K50.911`	Crohn's disease, unspecified, without complications	Localized Crohn disease with stricturing or recurrent obstruction may require segmental resection.
`C18.9`	Malignant neoplasm of colon, unspecified	Colon cancer localized to a segment often treated with resection and primary anastomosis.
`K55.9`	Vascular disorder of intestine, unspecified	Segmental ischemia may necessitate resection of nonviable colon with reconnection if feasible.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44140`	Colectomy, partial; with anastomosis, for example, resection of sigmoid colon with colorectal anastomosis	Common alternative for segmental open colectomy without combined transanal approach; may be performed when transanal access not required.
`44204`	Laparoscopy, surgical, colectomy, partial; with anastomosis	Minimally invasive alternative to `44147`; used when laparoscopic approach is feasible.
`44145`	Colectomy, partial; with end colostomy and closure of distal segment (Hartmann procedure)	Performed when primary anastomosis is not feasible and diversion is required instead of immediate reconnection.
`44160`	Colectomy, total, proctocolectomy or colectomy with ileostomy or ileoproctostomy	Used for more extensive disease requiring total colectomy rather than segmental resection.
`44227`	Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy	Related when extended resection includes terminal ileum and a different anastomosis configuration is required.