CPT 44604: Colon Repair Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 44604: Repair of Colon Tear with Peritoneal Irrigation

CPT code 44604 denotes surgical repair of a tear or perforation in the large intestine with suture closure and intra-abdominal irrigation. This code captures a clinically significant acute operative intervention used to prevent contamination of the peritoneal cavity and to reduce infectious complications following colonic injury or perforation. Nationally, procedures coded with CPT code 44604 are relevant for emergency general surgery, trauma care, and colorectal surgical services and have implications for hospital quality measures, resource utilization, and post-operative infection prevention strategies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and common billing considerations tied to this operative colon repair. The publication outlines benchmarks and reimbursement contexts, discusses policy and coding updates affecting operative colorectal procedures, and summarizes coding relationships and documentation expectations for accurate claim submission. The content is designed for coding professionals, surgical departments, and revenue cycle teams seeking a clear, national-level reference for CPT code 44604. Data not available in the input for payer-specific rates, associated taxonomies, and ICD-10 diagnosis pairings.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 44604colon repaircolonic perforationsurgical proceduregeneral surgeryoperating room proceduresperitoneal irrigationpostoperative infection preventionemergency surgery

Billing Code Overview

CPT code 44604 describes surgical repair of a tear or hole in the large intestine (colon) with suture repair and abdominal cavity irrigation using an antibiotic solution or normal saline. The procedure is performed to prevent contamination of the abdominal cavity by intestinal contents and to reduce the risk of intra-abdominal infection.

Service type: Surgical repair (open or operative) of colon perforation/tear with peritoneal irrigation

Typical site of service: Inpatient or outpatient operating room — commonly performed in the hospital surgical suite, often as an urgent or emergent procedure when bowel integrity is compromised.

Clinical & Coding Specifications

Clinical Context

A 46-year-old male presents to the emergency department with acute abdominal pain, fever, and signs of peritonitis after sustaining a penetrating abdominal injury. CT imaging demonstrates a full-thickness tear of the sigmoid colon with free intraperitoneal air and fluid. The surgical team takes the patient to the operating room for exploratory laparotomy. Intraoperatively, the surgeon identifies a 2.5 cm perforation in the sigmoid colon with localized contamination. The provider performs a primary repair of the colon defect using interrupted absorbable sutures, copiously irrigates the abdominal cavity with antibiotic solution, and places drains as indicated. The procedure is documented as an open repair of colonic perforation to prevent fecal soiling and intra-abdominal infection.

Typical clinical workflow:

Preoperative evaluation in the ED with labs, IV antibiotics, and imaging.
Informed consent documenting indication for repair of colon perforation.
Transport to OR; general anesthesia administered by anesthesia team.
Exploratory laparotomy, identification of colonic tear, debridement if necessary, primary suture repair, abdominal irrigation with antibiotic or normal saline, and hemostasis.
Placement of drains or proximal diversion only if indicated; closure and postoperative monitoring in PACU and surgical ward.

Typical site of service: Hospital inpatient operating room (emergency or urgent laparotomy setting).

Service type: Open surgical repair of colon perforation with abdominal irrigation and contamination control.

Coding Specifications

Related Codes

CPT-44660-ENTEROVESICAL-FISTULA-CLOSURE

CPT 44660: Closure of Enterovesical Fistula

CPT-44625-ENTEROSTOMY-REVISION-SURGICAL-REPAIR

CPT 44625: Revision of Enterostomy, Surgical Repair

CPT-44640-INTESTINAL-CUTANEOUS-FISTULA-CLOSURE-WITH-RESECTION

CPT 44640: Closure of Intestinal Cutaneous Fistula, with Resection if Needed

CPT-44650-ENTERIC-FISTULA-CLOSURE

CPT 44650: Enteroenteric or Enterocolic Fistula Closure

CPT-44680-BOWEL-FOLDING-AND-SUTURING-FOR-STABILIZATION

CPT 44680: Bowel Folding and Suturing to Prevent Fistula, Adhesions

CPT-44620-ENTEROSTOMY-CLOSURE

CPT 44620: Enterostomy Closure to Restore Intestinal Continuity

CPT-44615-INTESTINAL-STRICTURE-REPAIR-ENTEROTOMY-ENTERORRHAPHY

CPT 44615: Repair of Intestinal Stricture by Enterotomy or Enterorrhaphy

CPT-44602-SMALL-INTESTINE-REPAIR-WITH-PERITONEAL-IRRIGATION

CPT 44602: Small Intestine Repair with Peritoneal Irrigation

CPT-44626-COLORECTAL-ANASTOMOSIS-ENTEROSTOMY-TAKEDOWN

CPT 44626: Colorectal Anastomosis After Enterostomy Takedown

CPT-44661-ENTEROVESICAL-FISTULA-REPAIR-RESECTION-CLOSURE

CPT 44661: Enterovesical Fistula Repair with Resection and Closure

Showing 1–10 of 12

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical (extensive contamination, difficult repair).
`23`	Unusual anesthesia	Use when a procedure is performed under general anesthesia but anesthesia services are contraindicated or not possible; rarely applied to surgical coding—document carefully.
`26`	Professional component	Use if separate reporting of professional component is required (rare for operative CPTs).
`50`	Bilateral procedure	Use if bilateral colonic repairs are performed (rare for this code).
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when procedure is terminated due to patient instability prior to completion.
`54`	Surgical care only	Use when only the surgeon’s portion is billed and another provider bills pre/postoperative care.
`56`	Preoperative management only	Use when only preoperative management is billed separately by another provider.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure not normally reported together (e.g., separate incision/repair at a distinct site).
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`63`	Procedure performed on infants less than 4 kg	Use for neonates meeting weight criteria.
`78`	Unplanned return to operating room following initial procedure for a related procedure during postoperative period	Use when patient returns to OR for complication of the initial repair.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an accredited assistant at surgery from nonphysician provider bills.

Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	General surgeons most commonly perform open colon repairs for perforation.
2080P0003X	Colon and Rectal Surgery	Colon and rectal surgeons perform complex colonic repairs and contamination management.
208600000X	Trauma Surgery	Trauma surgeons commonly manage acute colon injuries in the emergency setting.
207L00000X	Surgical Critical Care	Surgical intensivists often manage postoperative critical care for these patients.
207RP3000X	Acute Care Surgery	Acute care surgeons who combine trauma and emergency general surgery care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K63.1`	Perforation of intestine (nontraumatic)	Represents nontraumatic colonic perforation that requires surgical repair and irrigation.
`K57.20`	Diverticulosis of large intestine without perforation or abscess	Diverticular disease can progress to perforation requiring repair; use when diverticulitis leads to perforation.
`K57.32`	Diverticulitis of large intestine with perforation and abscess	Direct indication for surgical repair of perforated colon and intra-abdominal irrigation.
`S36.511A`	Laceration of colon, initial encounter	Traumatic colon lacerations from penetrating or blunt trauma requiring primary repair.
`A04.7`	Enterocolitis due to Clostridium difficile	Severe infectious colitis can lead to perforation and need for operative repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue, first 20 sq cm or less	May be performed concurrently if wound debridement of abdominal wall or contaminated soft tissue is required prior to or during laparotomy.
`49000`	Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)	Often performed immediately prior to identification and repair of colonic perforation.
`44605`	Colectomy, partial; with primary anastomosis	May be performed instead of primary repair when contamination or tissue loss precludes simple repair.
`44120`	Enterolysis (separation of intestinal adhesions)	Performed when adhesions complicate access to the perforation site during laparotomy.
`10160`	Puncture aspiration of abscess (eg, abdominal abscess)	May be performed preoperatively or postoperatively for localized intra-abdominal abscess drainage.
`49560`	Removal of infected or necrotic mesh or device from abdominal wall	Relevant if prior mesh is infected and contributes to contamination requiring address during surgery.