CPT 44155 Proctocolectomy Reimbursement | OpenPayer

Summary & Overview

CPT 44155: Proctocolectomy with End Ileostomy

CPT code 44155 designates a major abdominal operation in which the total colon and rectum are removed and the terminal ileum is matured to the abdominal skin as an ileostomy. This procedure is a definitive surgical treatment for conditions requiring removal of the colon and rectum with diversion, and it has significant implications for inpatient surgical care, perioperative resource use, and postoperative management. Nationally, accurate reporting of CPT code 44155 is important for clinical tracking, quality measurement, and reimbursement alignment for complex colorectal surgery. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for CPT code 44155, typical sites of service, and the service type. The publication also outlines common modifiers and related billing considerations, benchmarks where available, and policy or coverage updates relevant to inpatient colorectal surgical procedures. Where input data are incomplete, the text notes that specific elements are not available. This summary is written for a national audience and focuses on clinical and billing clarity for institutions and payers handling major colorectal resections with end ileostomy.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare44155CPTproctocolectomyileostomycolorectal surgeryinpatient surgerysurgical billingoperating room

Billing Code Overview

CPT code 44155 describes a surgical procedure in which the total colon and rectum are removed (proctocolectomy) and the terminal ileum is brought to the abdominal skin as an ileostomy. This operation results in diversion of the intestinal stream through a stoma on the abdominal wall.

Service type: Major abdominal surgical procedure (proctocolectomy with end ileostomy)
Typical site of service: Inpatient hospital operating room with postoperative inpatient care

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with refractory inflammatory bowel disease (such as ulcerative colitis) or synchronous/multifocal colorectal neoplasia who requires removal of the entire colon and rectum with creation of a permanent end ileostomy. The patient presents after failed medical management, ongoing severe colitis with bleeding, or cancerous/neoplastic lesions not amenable to segmental resection. Preoperative workflow includes confirmatory colonoscopy and imaging, multidisciplinary surgical consent, bowel preparation as applicable, optimization of nutrition and comorbidities, informed discussion of ostomy care, and coordination with enterostomal therapy nursing.

Intraoperative workflow involves general anesthesia, midline laparotomy or laparoscopic approach converted as needed, total proctocolectomy with mesenteric vascular control, rectal cuff removal or mucosectomy when indicated, and creation of a terminal ileostomy matured to the abdominal wall. Postoperative care includes pain control, early mobilization, ostomy education, monitoring for complications (bleeding, anastomotic leak if staged procedure, small-bowel obstruction, wound infection), and discharge planning with outpatient ostomy follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier / default status	Use when no specific modifier applies; not typically appended in claims if billing system omits it.

CPT 44156: Total Colectomy with Ileal Pouch Continent Ileostomy

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

CPT 44140: Partial Colectomy with Primary Anastomosis

CPT-44150-TOTAL-COLECTOMY-ILEOSTOMY-OR-ILEORECTAL-ANASTOMOSIS

CPT 44150: Total Colectomy with Ileostomy or Ileorectal Anastomosis

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

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

CPT-44100-SMALL-INTESTINE-CAPSULE-BIOPSY

CPT 44100: Small Intestine Biopsy via Oral Capsule

CPT-44157-TOTAL-PROCTOCOLECTOMY-ILEOANAL-ANASTOMOSIS

CPT 44157: Total Proctocolectomy with Ileoanal Anastomosis

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

CPT 44144: Colon Resection with Colostomy and Mucous Fistula

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

CPT 44130: Intestinal Anastomosis, With or Without Stoma

CPT-44151-TOTAL-COLECTOMY-ILEAL-POUCH-CONTINENT-ILEOSTOMY

CPT 44151: Total Colectomy with Ileal Pouch and 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
`207P00000X`	Colon & Rectal Surgery	Primary specialty performing total proctocolectomy and ileostomy creation.
`207L00000X`	General Surgery	Frequently performs colorectal resections and ostomy creation in many centers.
`2080P0207X`	Surgical Oncology	Involved when procedure is for colorectal malignancy requiring oncologic resection.
`3336C0002X`	Ostomy Care (Enterostomal Therapy Nurse)	Provides perioperative and postoperative stoma education and management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K51.90`	Ulcerative colitis, unspecified, without complications	Common indication for total proctocolectomy with end ileostomy when disease is refractory.
`K51.92`	Ulcerative colitis, unspecified, with both rectal and colonic involvement	Represents extensive colonic and rectal disease necessitating proctocolectomy.
`C18.9`	Malignant neoplasm of colon, unspecified	Colorectal cancer requiring total removal when multifocal or synchronous lesions present.
`C20`	Malignant neoplasm of rectum	Rectal malignancy that may require rectal removal and permanent ileostomy.
`K50.919`	Crohn's disease, unspecified, without complications	Selected severe pan-colonic Crohn's disease cases may require total proctocolectomy and diversion.
`I82.409`	Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity	Example of a perioperative complication risk (venous thromboembolism) monitored in major abdominal surgery.
`K91.3`	Intestinal malabsorption following gastrointestinal surgery	Postoperative diagnosis related to consequences of total colectomy and ileostomy (eg, high-output ileostomy).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44141`	Colectomy, partial; with ileostomy or ileoproctostomy (separate procedure)	Performed for partial colon resections that may precede or be contrasted with total proctocolectomy; used when only a segmental colectomy with ileostomy is indicated.
`44143`	Colectomy, total; with ileostomy (separate procedure)	Alternative coding for total colectomy with ileostomy when rectum is not removed; related when rectal preservation is possible.
`44160`	Colectomy, partial; with skin level cecostomy or colostomy	Represents other stoma-creating procedures that may be considered in different clinical scenarios.
`44625`	Revision of enterostomy (eg, ileostomy)	Performed when stoma requires revision or takedown following complications or functional issues after the initial creation.
`44320`	Enterostomal therapy services (education/management) — note: CPT descriptor varies	Represents perioperative ostomy education and management by specialized nursing; often billed by wound/ostomy clinics.
`45395`	Proctosigmoidoscopy; rigid or flexible, diagnostic with biopsy	Diagnostic endoscopic procedures performed preoperatively to assess mucosal disease or obtain tissue prior to definitive surgery.

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