Summary & Overview
CPT 44227: Enterostomy Takedown with Intestinal Anastomosis
CPT code 44227 denotes the surgical takedown of a previously created enterostomy with excision of scarred or devitalized bowel ends and primary anastomosis to restore normal intestinal continuity. This code captures a definitive reconstructive bowel procedure performed when an ostomy is reversed and continuity is re-established. Nationally, it is a significant code for surgical departments, inpatient quality metrics, and payer authorization and coverage policies because it involves operative risk, potential readmission drivers, and post-operative resource use.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is used, typical sites of service, and common billing considerations tied to operative complexity. The publication also outlines benchmarks and policy-relevant points affecting coverage and utilization review, including typical settings (inpatient hospital, outpatient hospital, ambulatory surgical center) and why accurate coding matters for case mix, quality reporting, and reimbursement.
The report summarizes what clinicians, coders, and administrators need to know about CPT code 44227: the clinical scenario it represents, implications for perioperative care and documentation, and where to look for payer-specific coverage rules. Data not available in the input are noted explicitly where relevant.
Billing Code Overview
CPT code 44227 describes the surgical takedown of a previously created enterostomy with resection of scarred or devitalized bowel ends and primary anastomosis to restore the normal intestinal tract. The procedure entails removal of the enterostomy and trimming of damaged tissue at the cut ends of the intestine, followed by suturing the two bowel ends together to reestablish continuity of the colon or small bowel.
Service Type: Surgical — Enterostomy Takedown with Intestinal Anastomosis
Typical Site of Service: Operating room in an inpatient or outpatient hospital setting, or ambulatory surgical center, depending on patient complexity and clinical indications.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of a permanent end colostomy following emergent colectomy for diverticulitis presents months later for elective restoration of bowel continuity. Preoperative evaluation confirms healed stoma site without active infection and adequate distal bowel length. The surgical team schedules an inpatient or ambulatory surgical center procedure to takedown the enterostomy, excise scarred or devitalized bowel ends, and perform an intestinal anastomosis to re-establish continuity of the gastrointestinal tract. Perioperative workflow includes informed consent, pre-op antibiotic prophylaxis, general anesthesia, stoma takedown with adhesiolysis as needed, resection of nonviable edges, hand-sewn or stapled anastomosis, hemostasis, and layered fascial and skin closure. Postoperative care includes monitoring for anastomotic leak, return of bowel function, pain control, venous thromboembolism prophylaxis, and discharge planning once oral intake and bowel function are adequate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used / default | Not typically appended; use when no other modifier applies |
11 | Physician billing for standard service |