CPT 44800 Excision Meckel’s Diverticulum Reimbursement | OpenPayer

Summary & Overview

CPT 44800: Excision of Meckel's Diverticulum or Omphalomesenteric Duct

CPT code 44800 denotes the surgical excision of a Meckel’s diverticulum or an omphalomesenteric duct, procedures intended to remove a saclike ileal outpouching or embryologic remnant that can cause bleeding or ulceration. Nationally, this code represents a focused abdominal surgical intervention performed in operating room settings and is relevant to surgical, gastrointestinal, and pediatric care pathways. The procedure carries implications for surgical resource use, hospital metrics, and payer coverage policies regarding operative management of small-bowel anomalies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when the procedure is used, typical sites of service, and the service type classification. The publication also outlines reimbursement and utilization benchmarks, prevailing payer policy considerations, and coding nuances that affect claim adjudication. Additionally, the report highlights clinical indications tied to bleeding and ulceration, operational settings for performance of the procedure, and areas where policy updates or payer guidance can affect coverage and billing practices. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare44800CPTMeckel's diverticulumomphalomesenteric ductabdominal surgeryoperative proceduresmall bowelsurgical coding

Billing Code Overview

CPT code 44800 describes the surgical excision of a Meckel’s diverticulum or an omphalomesenteric (yolk stalk) duct. The procedure removes an outpouching or remnant from the wall of the ileum to treat or prevent complications such as bleeding or ulceration of the intestinal lining.

Service type: Surgical excision (operative abdominal procedure)
Typical site of service: Inpatient or outpatient surgical setting, commonly performed in an operating room under general anesthesia

Clinical & Coding Specifications

Clinical Context

A pediatric patient, typically aged 2–12 years, presents to the emergency department with intermittent, painless lower gastrointestinal bleeding and iron-deficiency anemia. History and evaluation include abdominal exam, hemoglobin/hematocrit, and imaging such as technetium-99m pertechnetate scan (Meckel scan) or CT enterography showing an ileal outpouching consistent with a Meckel’s diverticulum. After confirmation of diagnosis and preoperative evaluation, the patient is scheduled for surgical excision of the Meckel’s diverticulum (CPT 44800). The clinical workflow includes preoperative consent, anesthesia evaluation (general anesthesia common), intraoperative exploratory laparotomy or laparoscopy, excision of the diverticulum (wedge resection or segmental small bowel resection with primary anastomosis if base involved), hemostasis, and standard postoperative recovery and monitoring for bleeding, infection, or ileus. Indications include recurrent bleeding, ulceration, obstruction, or suspected ectopic gastric mucosa causing erosion. Typical site of service is an inpatient hospital operating room or ambulatory surgery center when clinically appropriate. Common providers performing this procedure include pediatric surgeons, general surgeons, and colorectal surgeons when indicated.

Coding Specifications

Modifier table

Modifier	Description	When to Use
`00`

CPT 44820: Excision of Peritoneal or Mesenteric Lesion

Taxonomy Code	Specialty	Notes
`207P00000X`	General Surgery	Most common specialty performing Meckel’s diverticulectomy
`2080P0206X`	Pediatric Surgery	Frequent provider for pediatric patients with Meckel’s diverticulum
`207Q00000X`	Colon & Rectal Surgery	Involved when pathology extends into distal small bowel or complex bowel reconstruction needed
`2086S0127X`	Pediatric Gastroenterology	Often involved in preoperative diagnosis and evaluation but not primary operator
`208D00000X`	General Practice/Family Medicine	May be involved in initial presentation and referral coordination

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K57.20`	Diverticulitis of large intestine without perforation or abscess	Data not directly relevant to Meckel’s but illustrates diverticular disease codes; use of diverticulitis codes is not typical for Meckel’s
`K31.2`	Meckel's diverticulum	Direct diagnostic code describing the lesion excised with `CPT 44800`
`K92.2`	Gastrointestinal hemorrhage, unspecified	Presents with GI bleeding; used when source is GI hemorrhage prior to localization
`D50.9`	Iron deficiency anemia, unspecified	Common presentation due to chronic bleeding from ectopic gastric mucosa in Meckel’s diverticulum
`K56.69`	Other intestinal obstruction	Used when Meckel’s diverticulum causes small bowel obstruction (volvulus or intussusception)

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Enterectomy, resection of small intestine with primary anastomosis	Performed when segmental small bowel resection is required due to broad-based Meckel’s diverticulum or ischemic bowel
`44320`	Enterolysis (separation of adhesions), small intestine	May be performed intraoperatively for adhesive disease discovered during exploration
`47562`	Laparoscopy, surgical; cholecystectomy (for example)	Example of concurrent laparoscopic procedures in same operative session; not specific but illustrates laparoscopic access codes may be used when combined minimally invasive approaches are performed
`49000`	Exploratory laparotomy, exploratory celiotomy with or without biopsy(s)	Used when a formal exploratory laparotomy is performed in conjunction with excision of Meckel’s diverticulum
`00840`	Anesthesia for procedures on the lower abdomen	Anesthesia code commonly billed by anesthesia providers when operating in the lower abdominal/ileal region

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