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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.

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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.

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CPT 44650: Enteroenteric or Enterocolic Fistula Closure

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Billing Code Overview

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.
`22`	Increased procedural services	Use when the procedure requires substantially greater work than usual (extensive adhesiolysis, prolonged operative time, unexpected complexity).
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the procedure is started but halted due to patient instability or unexpected findings.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure was performed on a different anatomical site or at a different session.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons on the procedure.
`76`	Repeat procedure by same physician (not in list)	Data not available in the input.
`78`	Unplanned return to OR	Use when the patient requires an unplanned return to the operating room for related treatment during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon performs part of the procedure.
`22`	(duplicate entry avoided)	Data not available in the input.

Taxonomy Code	Specialty	Notes
Data not available in the input.	Data not available in the input.	Data not available in the input.
Data not available in the input.	Data not available in the input.	Data not available in the input.
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K63.2`	Fistula of intestine	Direct diagnosis indicating presence of an enteroenteric or enterocolic fistula requiring closure.
`K56.5`	Intestinal adhesions (bands) with obstruction	Adhesions may underlie fistula formation or complicate access and repair.
`K65.0`	Acute peritonitis	Represents intra-abdominal infection that can be caused or exacerbated by enteric fistulae.
`K57.30`	Diverticulosis of large intestine with perforation and abscess without bleeding	Colonic disease with abscess or perforation can be associated with enterocolic fistula formation.
`T81.4`	Infection following a procedure, not elsewhere classified	Postoperative infection can lead to enteric fistula formation or complicate repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Enterolysis (separate procedure) — small intestine	Performed preoperatively or intraoperatively for extensive adhesions to expose the fistula prior to fistula takedown.
`44121`	Colectomy, partial; with anastomosis (small intestine to colon anastomosis)	Performed when resection of diseased bowel segments with primary anastomosis is required as part of fistula management.
`44140`	Colectomy, partial; with colostomy or ileostomy	Used when a diversion (stoma) is created to protect a repair or control sepsis.
`49420`	Placement of peritoneal drainage catheter	Performed when intra-abdominal abscess drainage is required in conjunction with fistula treatment.
`44970`	Laparoscopy, surgical; enterolysis	Performed laparoscopically in selected cases to manage adhesions and access fistula tracts.

CPT 44602: Small Intestine Repair with Peritoneal Irrigation

CPT-44603-SMALL-INTESTINE-SURGERY

CPT 44603: Small Intestine Surgical Procedure

CPT-44604-COLON-REPAIR-WITH-PERITONEAL-IRRIGATION

CPT 44604: Repair of Colon Tear with Peritoneal Irrigation

CPT-44605-COLON-REPAIR-WITH-COLOSTOMY

CPT 44605: Repair of Large Intestine With Colostomy

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

CPT 44615: Repair of Intestinal Stricture by Enterotomy or Enterorrhaphy

CPT-44620-ENTEROSTOMY-CLOSURE

CPT 44620: Enterostomy Closure to Restore Intestinal Continuity

CPT-44625-ENTEROSTOMY-REVISION-SURGICAL-REPAIR

CPT 44625: Revision of Enterostomy, Surgical Repair

CPT-44626-COLORECTAL-ANASTOMOSIS-ENTEROSTOMY-TAKEDOWN

CPT 44626: Colorectal Anastomosis After Enterostomy Takedown

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

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

CPT-44660-ENTEROVESICAL-FISTULA-CLOSURE

CPT 44660: Closure of Enterovesical Fistula

Showing 1–10 of 12

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, additional procedural service	Use when this procedure is the primary, straightforward service performed without complications.
`22`	Increased procedural services	Use when the procedure requires substantially greater work than usual (extensive adhesiolysis, prolonged operative time, unexpected complexity).
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the procedure is started but halted due to patient instability or unexpected findings.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure was performed on a different anatomical site or at a different session.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons on the procedure.
`76`	Repeat procedure by same physician (not in list)	Data not available in the input.
`78`	Unplanned return to OR	Use when the patient requires an unplanned return to the operating room for related treatment during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon performs part of the procedure.
`22`	(duplicate entry avoided)	Data not available in the input.

Taxonomy Code	Specialty	Notes
Data not available in the input.	Data not available in the input.	Data not available in the input.
Data not available in the input.	Data not available in the input.	Data not available in the input.
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K63.2`	Fistula of intestine	Direct diagnosis indicating presence of an enteroenteric or enterocolic fistula requiring closure.
`K56.5`	Intestinal adhesions (bands) with obstruction	Adhesions may underlie fistula formation or complicate access and repair.
`K65.0`	Acute peritonitis	Represents intra-abdominal infection that can be caused or exacerbated by enteric fistulae.
`K57.30`	Diverticulosis of large intestine with perforation and abscess without bleeding	Colonic disease with abscess or perforation can be associated with enterocolic fistula formation.
`T81.4`	Infection following a procedure, not elsewhere classified	Postoperative infection can lead to enteric fistula formation or complicate repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Enterolysis (separate procedure) — small intestine	Performed preoperatively or intraoperatively for extensive adhesions to expose the fistula prior to fistula takedown.
`44121`	Colectomy, partial; with anastomosis (small intestine to colon anastomosis)	Performed when resection of diseased bowel segments with primary anastomosis is required as part of fistula management.
`44140`	Colectomy, partial; with colostomy or ileostomy	Used when a diversion (stoma) is created to protect a repair or control sepsis.
`49420`	Placement of peritoneal drainage catheter	Performed when intra-abdominal abscess drainage is required in conjunction with fistula treatment.
`44970`	Laparoscopy, surgical; enterolysis	Performed laparoscopically in selected cases to manage adhesions and access fistula tracts.

CPT 44602: Small Intestine Repair with Peritoneal Irrigation

CPT-44603-SMALL-INTESTINE-SURGERY

CPT 44603: Small Intestine Surgical Procedure

CPT-44604-COLON-REPAIR-WITH-PERITONEAL-IRRIGATION

CPT 44604: Repair of Colon Tear with Peritoneal Irrigation

CPT-44605-COLON-REPAIR-WITH-COLOSTOMY

CPT 44605: Repair of Large Intestine With Colostomy

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

CPT 44615: Repair of Intestinal Stricture by Enterotomy or Enterorrhaphy

CPT-44620-ENTEROSTOMY-CLOSURE

CPT 44620: Enterostomy Closure to Restore Intestinal Continuity

CPT-44625-ENTEROSTOMY-REVISION-SURGICAL-REPAIR

CPT 44625: Revision of Enterostomy, Surgical Repair

CPT-44626-COLORECTAL-ANASTOMOSIS-ENTEROSTOMY-TAKEDOWN

CPT 44626: Colorectal Anastomosis After Enterostomy Takedown

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

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

CPT-44660-ENTEROVESICAL-FISTULA-CLOSURE

CPT 44660: Closure of Enterovesical Fistula

Showing 1–10 of 12

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 44650: Enteroenteric or Enterocolic Fistula Closure

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Billing Code Overview

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CPT 44650: Enteroenteric or Enterocolic Fistula Closure

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References