Summary & Overview
CPT 44320: Colostomy/Cecostomy (Loop) Stoma Creation
CPT code 44320 denotes the surgical creation of an intestinal stoma by exteriorizing a loop of colon or cecum through the abdominal wall, opening the intestinal wall, and suturing it to the skin to provide direct access for emptying. This procedure is important nationally for managing bowel obstruction, severe fecal incontinence, palliative decompression, and situations requiring temporary or permanent diversion of fecal flow.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, typical sites of service, and the kinds of billing contexts in which 44320 is used. The publication covers payment and coverage benchmarking themes, common payer policy considerations, and clinical context relevant to coding and billing for ostomy creation procedures.
The analysis is intended for a national audience of revenue cycle professionals, clinicians involved in surgical coding, and policy analysts seeking an authoritative summary of the code’s clinical purpose and billing relevance. Data not available in the input will be indicated where applicable.
Billing Code Overview
CPT code 44320 describes a surgical procedure in which the surgeon brings a small loop of the large intestine (colon or cecum) through an incision in the abdominal wall, opens that intestinal segment, and sutures it to the abdominal wall to provide direct access to the intestines for emptying. This procedure is typically performed to create a controlled stoma for decompression or ongoing intestinal access.
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Service type: Surgical ostomy creation / stoma formation
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Typical site of service: Hospital operating room or inpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with chronic, intractable constipation and recurrent fecal impaction presents after multiple failed medical therapies and enemas. The surgical team elects to create a temporary end colostomy/ileostomy-type access to the colon (loop colostomy) to allow direct decompression and enteric diversion. Preoperative evaluation includes bowel prep as tolerated, anesthesia assessment, informed consent discussing stoma care, and coordination with enterostomal therapy nursing. In the operating room under general anesthesia, the surgeon identifies a loop of colon (typically transverse colon or sigmoid colon), delivers a small loop through a right or left lower quadrant incision or midline incision in the abdominal wall, makes a longitudinal enterotomy, and matures the bowel edges to the skin to create a stoma for evacuation. Postoperative workflow includes stoma appliance fitting, patient education, monitoring for ischemia or infection, and discharge planning with outpatient ostomy follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard claim submission | Use when no additional circumstances modify the service. |
11 | Decision for surgery |