Summary & Overview
CPT 44605: Repair of Large Intestine With Colostomy
CPT code 44605 identifies an operative colorectal procedure in which the surgeon repairs a perforation or tear of the large intestine with sutures, irrigates the abdomen, and creates a colostomy to divert fecal material and protect the repair. This intervention is clinically significant because it directly addresses contamination risk and sepsis potential following colonic injury or perforation, and it carries implications for surgical quality, length of stay, and post‑acute planning.
Key payers considered in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise context on the clinical purpose and typical care setting for the code, plus the types of benchmarks and policy topics commonly associated with this service: utilization patterns for emergent colorectal repairs, inpatient surgical payment considerations, and implications for discharge planning and ostomy care coverage. The summary highlights what to expect in a deeper analysis: service-level benchmarks (where available), payer coverage constructs and authorization practices, and clinical considerations relevant to coding and claim submission. Data not available in the input is identified as such for missing specific items like associated taxonomies, exact ICD-10 pairings, and payer-specific reimbursement rates.
Billing Code Overview
CPT code 44605 describes a surgical procedure in which a provider repairs a tear or hole in the large intestine (colon) with sutures and irrigates the abdominal cavity with an antibiotic solution or normal saline. The procedure includes creation of a colostomy to divert fecal flow into an external appliance, intended to protect the repair site and reduce the risk of contamination and infection while healing.
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Service type: Emergency or operative abdominal surgery for colon repair with protective colostomy
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Typical site of service: Inpatient operating room with post-operative inpatient care
Clinical & Coding Specifications
Clinical Context
A 54-year-old male presents to the emergency department after blunt abdominal trauma with signs of peritonitis, hypotension, and an acute abdomen. Imaging and diagnostic peritoneal lavage reveal a perforation of the sigmoid colon with fecal contamination of the peritoneal cavity. In the operating room under general anesthesia, the surgeon performs exploration, identifies a full-thickness tear of the large intestine, performs primary repair of the colonic laceration with sutures, irrigates the peritoneal cavity with antibiotic solution or normal saline, and creates a diverting end colostomy to protect the repair and prevent ongoing contamination while the injury heals. The typical workflow includes preoperative consent and antibiotics, induction of anesthesia, exploratory laparotomy, colonic repair, abdominal washout, formation of colostomy, abdominal closure or temporary closure if required, and postoperative monitoring in the surgical ward or intensive care unit depending on hemodynamic status. Typical site of service is the operating room in an inpatient hospital setting. Service type is open abdominal surgical repair with fecal diversion (colostomy) performed for trauma, perforated diverticulitis, ischemic colitis with perforation, or other causes of colonic perforation requiring diversion.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no specific modifier applies. |