CPT code 44120 – Enterectomy with small bowel resection and anastomosis

Key takeaways

CPT code 44120 describes an open (not laparoscopic) single resection and anastomosis of the small intestine only.

The anastomosis must be explicitly documented in the operative report. Missing this detail is the leading cause of denial.

A case that ends with a stoma instead of an anastomosis is reported with 44125, not 44120.

44120 pairs with add-on code 44121 for each additional resection. Billing multiple units of 44120 itself is an unbundling error.

The 2026 Medicare national facility rate is about $1,064 before geographic practice cost index (GPCI) adjustments apply by locality.

CPT code 44120: Official descriptor and procedure overview

CPT code 44120 is the billing code for an open enterectomy with a single small intestine resection and anastomosis. It is defined in the American Medical Association’s CPT code set. The full official descriptor reads: Enterectomy, resection of small intestine; single resection and anastomosis.

Two elements define the code precisely. First, the approach must be open, not laparoscopic. Second, a completed anastomosis must be performed during the same operative session. A resection that ends with a stoma instead of an anastomosis is reported with 44125.

The 44100-44160 range covers several open intestinal excisions, but 44120 is the only one that pairs a single small bowel resection with an anastomosis. A laparoscopic case billed as 44120 is miscoded before the claim leaves the practice.

Procedure description: What happens during a 44120 enterectomy

An open small bowel resection with anastomosis follows a predictable surgical sequence. Understanding the steps helps coders verify that an operative note supports 44120 rather than a related code.

1. Patient positioning and incision: The patient is placed supine. A midline laparotomy incision provides access to the peritoneal cavity.
2. Bowel mobilization: The affected segment of jejunum, ileum, or duodenum is identified. Mesenteric vessels supplying the diseased segment are ligated and divided.
3. Resection: The surgeon transects the bowel at both margins of the diseased segment. This is the “single resection” the descriptor refers to.
4. Anastomosis: The two bowel ends are joined, either end-to-end, side-to-side, or end-to-side, restoring intestinal continuity. This step is what separates 44120 from 44125, where the bowel is brought out as a stoma instead.
5. Closure: The mesenteric defect is repaired, the abdomen is irrigated, and wound closure is performed in layers.

The anastomosis step is the clinical and coding pivot point. If the operative note describes resection but then documents stoma creation instead of reanastomosis, 44120 does not apply and 44125 does.

What CPT 44120 includes and excludes

Bundling rules for CPT code 44120 are stricter than many coders expect. The following table separates what is already valued inside 44120 from what can be legitimately reported separately.

CPT 44120 vs 44125: Anastomosis or stoma

CPT codes 44120 and 44125 describe the same open single resection of the small intestine but differ on how the operation ends. With 44120, the surgeon rejoins the two bowel ends with an anastomosis. With 44125, the surgeon brings the bowel out through the abdominal wall as an enterostomy, creating a stoma.

If the operative report documents a stoma instead of reconnection, 44125 is the supported code. Code 44120 applies to a standard open single-segment resection that ends with an anastomosis. Tapering for congenital atresia belongs to neither code and is reported with 44126 or 44127.

Related and commonly confused CPT codes for small bowel resection

Several adjacent codes share procedural territory with CPT code 44120, and the distinctions are granular enough to slip past automated edits. This reference table covers the neighbors coders confuse most often.

Checking the operative note against these distinctions during charge capture review catches most approach and anatomy mismatches before a claim is filed. The decision path below runs those checks in the order a coder should ask them.

ICD-10 diagnosis codes commonly paired with CPT 44120

Every payer requires a diagnosis code that supports medical necessity for 44120. The diagnosis must be clinically consistent with an open bowel resection. A nonspecific or low-acuity code triggers a medical necessity denial, however accurate the procedure code is.

Local coverage determinations (LCDs) for intestinal resections typically require a primary diagnosis showing failed conservative management or an acute presentation. Coders should confirm the LCD their Medicare Administrative Contractor (MAC) applies in their region. For an oncologic resection, check whether C17.9 is specific enough, or whether the pathology report supports a site-level code.

Documentation requirements for billing CPT 44120

The operative report is the primary record for a 44120 claim. It must contain each of the following elements for the claim to hold up on audit.

• Confirmation of open approach: The note must explicitly state “open laparotomy” or “midline incision.” “Exploratory laparoscopy converted to open” qualifies if the conversion and reasons are documented.
• Anatomic location of resection: The specific bowel segment (for example, terminal ileum or proximal jejunum) and resection margins should be stated. Include the approximate length when possible.
• Anastomosis technique: The type of anastomosis (end-to-end, end-to-side, side-to-side) and method (hand-sewn, stapled) must be documented. Without this, there is no coding support for 44120 versus a non-anastomosis code.
• Intraoperative findings: Clinical findings justifying resection (ischemia, obstruction, tumor, perforation) must appear in the body of the operative report.
• Medical necessity statement: The preoperative diagnosis should align with the final pathological or intraoperative diagnosis.

Structured surgical note templates make these elements hard to skip. When the anastomosis field is mandatory rather than free text, the note reaches charge entry with the detail the coder needs.

Modifiers applicable to CPT code 44120

Modifier selection for CPT code 44120 is governed by AMA guidelines, but payer acceptance rates vary. Appending a modifier without meeting its clinical and documentation threshold is worse than omitting it. An unsupported modifier flags the claim for manual review and can trigger a denial with a fraud-risk note in the payer file.

Modifier -22 is the most frequently abused on 44120 claims. CMS and most commercial payers pay an additional 15 to 20 percent when the documentation justifies it. They also audit -22 usage aggressively. Practices that append -22 to every 44120 claim without case-specific narrative documentation are building an audit target.

2026 Medicare reimbursement, fee schedule, and RVU breakdown for CPT 44120

CMS publishes the 2026 Medicare Physician Fee Schedule (MPFS) values for CPT code 44120 in its fee schedule lookup tool. They reflect the CY 2026 final rule. All figures below are national unadjusted rates. Your reimbursement varies by geographic practice cost index (GPCI) locality.

The CY 2026 conversion factor is $33.4009 per RVU, or $33.57 for qualifying alternative payment model (APM) participants. At the standard rate, the facility total of 31.87 RVUs works out to roughly $1,064 at the national average GPCI. You can check the current values with FastRVU’s 2026 RVU lookup. Non-facility rates are substantially higher because the practice bears the overhead cost of the supply, equipment, and staff.

For locality-adjusted figures, the free 2026 RVU calculator from PCC imports CMS data and applies GPCI multipliers.

Common claim denial reasons for CPT 44120 and how to avoid them

Most 44120 denials fall into five recurring patterns. Each one is preventable at the coding or documentation stage. Knowing the medical billing denial codes helps coders trace each remittance remark code back to its root cause instead of resubmitting blindly.

Denial management at the practice level starts with sorting denials by type before any claim is resubmitted. A billing team that tracks the most frequent reason code on 44120 claims can trace it to the surgical note template. Fixing the template once beats appealing claim by claim.

On the 835 electronic remittance advice (ERA), claim adjustment reason codes (CARCs) separate approach, documentation, and medical necessity errors. The billing team can see the cause without calling the payer.

Payer-specific billing considerations for CPT code 44120

Medicare sets the floor for 44120 payment policy, but commercial payers frequently impose additional requirements. Practices billing 44120 to UnitedHealth, Aetna, or Cigna should check each payer’s own coverage determination before submission. Their prior authorization requirements and bundling rules differ from Medicare’s.

• Prior authorization: Most commercial payers require prior authorization for inpatient bowel resections. Confirm requirements through the payer’s portal before scheduling, not before billing. A retroactive denial for missing prior authorization is not appealable in most commercial contracts.
• Medicaid state-plan variations: Medicaid fee schedules for 44120 differ substantially by state. Some states reimburse at a percentage of Medicare; others use independently negotiated rates. Coders should confirm the applicable state rate annually.
• Global surgical period: 44120 carries a 90-day global surgical period under Medicare. Services that fall within this window, including related E/M visits, are generally not separately billable unless specific modifiers apply.
• CCI edit pairs: Check CMS Correct Coding Initiative edits before billing 44120 alongside any other intestinal procedure. CCI edits update quarterly, so a code pair that was separately billable in Q1 may be bundled in Q2.

Each payer’s rules for surgical codes belong in the practice’s billing reference library, reviewed at least once a year. Centralized claims software for surgeons catches payer-level edits when the claim is created, not after submission. Each payer’s own fee schedule also makes a practical baseline for a quarterly payment reconciliation.

How claims management software reduces errors for CPT code 44120

On many surgical billing teams, a 44120 claim is checked by hand. A coder reads the operative note, confirms the approach and the anastomosis, and picks the modifiers. Weeks later, someone matches the payment against the fee schedule in a spreadsheet.

Practice management software like Pabau keeps that work in one place. Charge capture, modifiers, and claim status sit beside the patient record and the appointment. Through its Claim.MD integration, Pabau lets US practices submit, track, and reconcile insurance claims without leaving the system.

The payoff is faster, cleaner reconciliation. Each 44120 payment is compared with the expected RVU-based amount line by line, so underpayments surface without manual matching.

Streamline surgical billing from charge capture to payment posting

Pabau’s claims management tools help surgical practices capture the right codes, attach the right modifiers, and track claim status through to ERA reconciliation. See how it works for your practice.

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Conclusion

CPT code 44120 rewards the coder who reads the whole operative note before picking a code. An open approach, a small bowel site, and a documented anastomosis are the three facts it rests on. If any one of them is missing, a different code applies.

The fix belongs upstream. Mandatory approach and anastomosis fields in the surgical note template take some setup, but they replace claim-by-claim appeals with a single change.

Book a demo to see how Pabau keeps surgical charge capture, modifiers, and payment reconciliation in one workflow.

Continue your research

Pairing 44120 with a small bowel cancer diagnosis? ICD-10 code C17.9 covers when the unspecified small intestine malignancy code supports an oncologic resection and when a more specific site code is expected.

Resecting bowel after a perforation? ICD-10 code K63.1 explains how to code nontraumatic intestinal perforation, one of the findings that justifies an open enterectomy.

Was the resection done laparoscopically on the colon instead? CPT code 44204 breaks down the laparoscopic partial colectomy code that coders most often confuse with 44120.

Did the case end with a stoma rather than an anastomosis? CPT code 44227 walks through billing the laparoscopic enterostomy closure that reverses the stoma later on.

Started laparoscopically and converted to open? CPT code 49320 clarifies when a diagnostic laparoscopy is bundled and when it can be reported alongside the open procedure.

Frequently asked questions