Summary & Overview
CPT 44650: Enteroenteric or Enterocolic Fistula Closure
CPT code 44650 represents surgical closure of an enteroenteric or enterocolic fistula — procedures that eliminate abnormal communications within the small intestine or between the small and large intestine to prevent infection, abscess, and other complications. This code is used for definitive operative management of enteric fistulas and is relevant to acute care surgeons, hospital billing teams, and surgical quality programs nationwide.
Key payers discussed in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, typical sites of service, and payer coverage considerations. The publication summarizes common billing modifiers associated with operative procedures, outlines service-line implications for inpatient and ambulatory surgical settings, and highlights where users should look for coding clarifications and related procedure codes.
This resource is intended for coding professionals, surgical billing departments, and policy analysts seeking a concise reference on code usage, clinical intent, and payer presence. Data not available in the input is explicitly noted where necessary.
Billing Code Overview
CPT code 44650 describes surgical closure of an enteroenteric or enterocolic fistula, a procedure that disconnects an abnormal communication between two points of the small intestine or between the small and large intestine. The goal of the procedure is to treat or prevent infection, abscess formation, and other complications arising from intestinal fistulas.
Service type: Surgical repair of intestinal fistula
Typical site of service: Inpatient hospital or outpatient surgical center, depending on patient condition and surgical complexity.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 58-year-old male with a chronic postoperative enterocutaneous fistula that communicates between a segment of small intestine and the colon, presenting with persistent drainage, recurrent intra-abdominal infection, and malnutrition despite conservative management. The surgical team evaluates enteric continuity and local tissue viability, obtains cross-sectional imaging (CT abdomen/pelvis with oral and IV contrast) and nutritional optimization, and discusses operative repair. In the operating room under general anesthesia, the surgeon performs adhesiolysis, isolates the fistulous tract, debrides inflamed margins, and performs primary takedown and closure of the enteroenteric or enterocolic fistula with layered intestinal repair or resection with anastomosis if required. Intraoperative cultures and pathology specimens may be obtained. Postoperative workflow includes monitoring for leak or abscess, bowel rest with nasogastric decompression as needed, broad-spectrum antibiotics guided by cultures, venous thromboembolism prophylaxis, pain control, and gradual advancement of diet. Discharge planning addresses wound care, stoma education if diversion was created, and outpatient follow-up for nutrition and infection surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, additional procedural service | Use when this procedure is the primary, straightforward service performed without complications. |