44140

Colectomy, partial; with anastomosis

Current Procedural Terminology (CPT) code 44140 represents a partial colectomy with anastomosis performed via an open abdominal approach. The colon, or large intestine, is a critical component of the digestive system responsible for absorbing water and electrolytes, as well as forming and propelling feces toward the rectum for expulsion. A partial colectomy involves the surgical resection of a diseased, injured, or otherwise compromised segment of this organ. Clinical conditions necessitating this procedure are wide-ranging and often include colorectal malignancies, severe or recurrent diverticulitis, complicated inflammatory bowel disease (such as Crohn's disease or ulcerative colitis), medically refractory ischemic colitis, large sessile polyps that cannot be safely managed via endoscopy, and cases of intestinal obstruction, volvulus, or trauma. During the procedure, the surgeon makes a midline laparotomy incision to access the abdominal cavity. After conducting a thorough exploration to assess the extent of the disease and confirm the surgical plan, the targeted segment of the colon is carefully mobilized. This mobilization requires the precise dissection of surrounding attachments and the meticulous ligation and division of the blood vessels supplying the affected bowel segment within the mesentery. Lymph node harvesting is concurrently performed if the indication is oncologic to ensure accurate staging. Following adequate mobilization and vascular control, the surgeon clamps and transects the colon proximally and distally to the diseased area, ensuring clear and healthy margins. The resected specimen is then removed from the surgical field and typically sent for histopathological examination. The critical reconstructive phase of the operation is the anastomosis, where the remaining healthy ends of the colon (or colon and small intestine, depending on the resection site) are rejoined to restore the continuity of the gastrointestinal tract. This anastomosis may be performed using hand-sewn sutures, surgical stapling devices, or a combination of both, in various configurations such as end-to-end, side-to-side, or end-to-side. The surgeon rigorously tests the integrity of the anastomosis, often by filling the pelvis with saline and insufflating air into the rectum, to confirm there are no leaks. Once hemostasis is secured and the surgical field is irrigated, the abdominal fascia and skin are closed in layers. Because CPT code 44140 specifically dictates an open approach with a primary anastomosis, it should not be utilized for laparoscopic resections, nor should it be applied when the procedure culminates in the creation of a colostomy or ileostomy, which are described by distinct procedural codes.

Clinical Indications

  • Malignant neoplasms of the colon (e.g., adenocarcinoma)
  • Severe, complicated, or recurrent diverticulitis
  • Large or complex benign colon polyps not amenable to endoscopic resection
  • Inflammatory bowel disease, including Crohn's disease and ulcerative colitis
  • Ischemic colitis with tissue necrosis or stricture
  • Colonic strictures or bowel obstruction
  • Volvulus (twisting of the intestine causing obstruction and potential ischemia)
  • Traumatic injury to the colon requiring resection

Procedure Steps

  1. The patient is placed under general anesthesia and positioned supine on the operating table.
  2. A standard midline laparotomy incision is made to access the abdominal cavity.
  3. The abdominal cavity is explored to assess the colon and surrounding structures, determining the exact margins for resection.
  4. The affected segment of the colon is mobilized by dissecting its fascial and peritoneal attachments.
  5. The mesentery associated with the diseased colon segment is divided, and the supplying blood vessels are individually ligated and cut.
  6. Surgical clamps are placed proximally and distally to the diseased section of the colon.
  7. The colon is transected and the diseased segment is removed from the sterile field and sent for pathological examination.
  8. A primary anastomosis is created by joining the two healthy ends of the remaining bowel using hand-sewn sutures or surgical staplers.
  9. The anastomosis is inspected and tested for leaks, typically via insufflation or a saline leak test.
  10. The peritoneal cavity is irrigated and inspected for adequate hemostasis.
  11. The abdominal incision is closed in multiple anatomic layers (fascia, subcutaneous tissue, skin), and sterile dressings are applied.

Coding Guidelines

  • Do not report CPT code 44140 for a laparoscopic partial colectomy. Use CPT code 44204 for the laparoscopic approach.
  • This code specifically includes a primary anastomosis. If a colostomy, ileostomy, or stoma is created instead of or in addition to the anastomosis, refer to codes 44141, 44143, 44144, 44146, or 44147.
  • Incidental appendectomy during this procedure is bundled and should not be reported separately unless the appendix is removed for an independent pathological indication or is located outside the primary resection field.
  • Lysis of adhesions is generally bundled into the primary surgical procedure. It may only be reported separately with modifier 22 if the adhesions are exceptionally dense and require significantly more time and effort than usually encountered.
  • Code 44140 can be used for right, left, sigmoid, or transverse open partial colectomies, provided an anastomosis is formed without a stoma.