CPT 44150 Total Colectomy Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 44150: Total Colectomy with Ileostomy or Ileorectal Anastomosis

CPT code 44150 represents a total colectomy with formation of an ileostomy or an ileorectal anastomosis, a major abdominal operation used for a range of severe colonic diseases. Nationally, this code is important for hospital surgical case mix, resource allocation, and postoperative care planning due to its association with extended inpatient stays and potential for complex postoperative management. Key payers included in typical coverage reviews are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical scope and coding definition of CPT code 44150, how it maps to service setting and surgical care pathways, and what to expect in payer coverage considerations at a national level. The publication also provides benchmarks and context for utilization patterns, common billing modifiers, and implications for surgical quality and discharge planning. Data not available in the input is noted where applicable, including specific ICD-10 diagnoses, associated taxonomies, and payer-specific reimbursement rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare44150CPTtotal colectomyileostomyileorectal anastomosiscolorectal surgeryinpatient surgerysurgical coding

Billing Code Overview

CPT code 44150 describes a surgical procedure in which the provider removes the total colon and creates either an ileostomy (bringing the end of the ileum to the skin) or an ileorectal anastomosis (connecting the ileum directly to the rectum). This procedure is a type of extensive colorectal surgery.

Service type: Major abdominal surgery involving total colectomy with diversion or anastomosis
Typical site of service: Inpatient hospital operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55–75-year-old individual with refractory ulcerative colitis, multifocal colonic neoplasia, or chronic colonic dysplasia who presents for elective total proctocolectomy with ileostomy or ileoanal anastomosis. The workflow includes preoperative evaluation (history and physical, colonoscopy with biopsy, imaging as indicated), multidisciplinary consent discussing potential permanent or temporary ileostomy versus ileal pouch-anal anastomosis, perioperative anesthesia assessment, and operative removal of the entire colon. Intraoperative steps include mobilization of the colon, control of mesenteric vessels, rectal preservation or resection depending on indication, and creation of either an end ileostomy (ileum to skin) or an ileorectal/ileoanal anastomosis. Postoperative care occurs in an inpatient surgical unit with stoma care teaching if an ileostomy is created, pain control, VTE prophylaxis, and monitoring for complications such as anastomotic leak, small-bowel obstruction, or wound infection. Typical sites of service are an inpatient hospital operating room and postoperative inpatient ward; ambulatory preoperative clinic and inpatient rehabilitation or skilled nursing may also be involved depending on recovery. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Used when no reporting modifier applies to the service

CPT 44111: Excision of Intestinal Lesions, Multiple Incisions

CPT-44155-PROCTOCOLECTOMY-WITH-END-ILEOSTOMY

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-44100-SMALL-INTESTINE-CAPSULE-BIOPSY

CPT 44100: Small Intestine Biopsy via Oral Capsule

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

CPT 44110: Open Excision of Intestinal Lesion(s), Single Incision

CPT-44135-SMALL-BOWEL-TRANSPLANT-WITH-CADAVER-INTESTINE-RECONSTRUCTION

CPT 44135: Small Bowel Transplant with Cadaver Donor Intestine

CPT-44140-PARTIAL-COLECTOMY-WITH-PRIMARY-ANASTOMOSIS

CPT 44140: Partial Colectomy with Primary Anastomosis

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

CPT 44130: Intestinal Anastomosis, With or Without Stoma

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

CPT 44156: Total Colectomy with Ileal Pouch Continent Ileostomy

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

CPT 44121: Additional Small Intestine Resection with Anastomosis

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Taxonomy Code	Specialty	Notes
207L00000X	Colon & Rectal Surgery	Colorectal surgeons most commonly perform total proctocolectomy and ileostomy/pouch creation
207W00000X	General Surgery	General surgeons with colorectal focus commonly perform this operation in many hospitals
208000000X	Surgery	Acute care or surgical specialists involved in complex operative care and perioperative management
363A00000X	Gastroenterology	Gastroenterologists are involved preoperatively for diagnostics and surveillance but do not perform the surgery
207K00000X	Surgical Oncology	Surgical oncologists may perform the procedure when malignancy is the indication

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K51.90`	Ulcerative colitis, unspecified, without complications	Common indication for total colectomy when disease is medically refractory
`K51.92`	Ulcerative colitis, unspecified, with rectal bleeding	Indicates active disease that may prompt surgical management including colectomy
`K50.912`	Crohn's disease of unspecified site, with rectal bleeding	In select extensive or refractory Crohn disease cases, proctocolectomy may be performed
`C18.9`	Malignant neoplasm of colon, unspecified	Colon cancer involving multiple segments may require total colectomy
`D12.6`	Benign neoplasm of colon, unspecified	Multiple or large benign neoplasms (e.g., polyposis) can indicate total colectomy
`K63.1`	Perforation of intestine (nontraumatic)	Acute complication that may necessitate emergency total colectomy
`K57.92`	Diverticulosis of large intestine with perforation and abscess	Complicated diverticular disease can lead to total colectomy in severe cases

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44151`	Proctocolectomy; total, with ileostomy or ileoproctostomy (including pouch procedures)	Closely related variant describing total proctocolectomy with ileostomy or ileoproctostomy — may be used when rectum also resected and pouch creation performed
`44204`	Laparoscopy, surgical, colectomy, partial; with ileocolostomy	Performed when a minimally invasive approach is used for partial colectomy; may be performed prior to or instead of total colectomy in other indications
`44625`	Closure of ileostomy, enterostomy, or enterocutaneous fistula; complicated	Used when a previously created ileostomy is closed in a later procedure; part of staged management when temporary ileostomy created during `44150` scenario
`45385`	Colonoscopy, flexible; with removal of tumor(s), polypectomy by snare technique	Diagnostic and therapeutic adjunct performed preoperatively for polyp or tumor diagnosis guiding the need for total colectomy
`49002`	Drainage of mesenteric or intra-abdominal abscess; percutaneous, with drainage catheter under imaging guidance	May be performed preoperatively or postoperatively for intra-abdominal abscess management related to colonic disease
`15734`	Muscle, myocutaneous or fasciocutaneous free flap with microvascular anastomosis	Occasionally used for complex abdominal wall reconstruction when extensive resection or infection requires tissue transfer

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