CPT code 44625 – Enterostomy closure with resection and anastomosis

Key takeaways

CPT code 44625 needs both a bowel resection and an anastomosis. A closure without resection maps to 44620 instead.

The phrase “other than colorectal” is binding. A colon-to-rectum join, such as a Hartmann’s reversal, is billed as 44626.

A frequent denial trigger is an operative report that never confirms the resection, so payers downcode the claim to 44620.

Medicare keeps 44625 on its inpatient-only list for CY2026, so an outpatient or ASC place of service gets the claim rejected.

Pabau’s claims management software pre-fills the claim from the record, validates required fields and submits through Claim.MD.

CPT code 44625 needs three things in one operation

CPT code 44625 reports an open enterostomy closure that includes a bowel resection and a non-colorectal anastomosis. The American Medical Association descriptor reads: Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectal.

The code sits in the Repair group of the Intestines (Except Rectum) codes, within the CPT Surgery chapter. All three elements must appear in the same operation. Remove any one of them, and a different code applies.

• A stoma is closed: a colostomy, ileostomy or jejunostomy of the large or small intestine.
• Bowel is resected: the segment bearing the stoma, or bowel next to it, is excised rather than closed in place.
• The ends are rejoined: the anastomosis restores continuity, and it doesn’t join colon to rectum.
• Colorectal joins are excluded: a colon-to-rectum anastomosis is billed as CPT 44626.

Surgeons resect when the stoma bowel isn’t safe to reuse

An enterostomy takedown with resection follows a predictable sequence. First, the surgeon mobilizes the stoma from the abdominal wall and frees the bowel from adhesions. Next, the segment bearing the stoma is resected, along with any compromised bowel nearby. Finally, an anastomosis restores continuity.

Resection is the step that separates 44625 from a simpler closure. In some takedowns, the surgeon freshens the stoma edges and closes the bowel in place. That approach maps to CPT 44620. Surgeons usually resect because of scarring at the stoma, ischemic or narrowed bowel ends, or a diseased segment.

Stoma type changes the picture too. A loop ileostomy with healthy edges may close without resection, so coding 44625 by default is an error. An end colostomy reversed after a Hartmann’s procedure usually needs a colorectal join, which points to 44626.

Two questions separate 44625 from 44620 and 44626

The open enterostomy closure codes form a tight family. Two questions sort them. Was bowel resected, and is the anastomosis colorectal?

Coders often confuse 44620 and 44625. The operative report must state that resection was performed. If it only records a “takedown” or “reversal,” payers default to 44620.

Approach comes before both questions. A laparoscopic closure with resection and anastomosis is reported with 44227, never with the open codes. The decision tree below puts all three checks in order.

The operative note has to prove the resection

The operative report must support all three elements of CPT code 44625. A clean claim starts with documentation specific enough to survive payer review without a records request.

Check the note for these five elements before coding:

• Confirmation of resection: the note states that a bowel segment was excised, not merely mobilized or freshened. “We resected the ileum bearing the stoma” is enough.
• Anastomosis technique: the type, such as hand-sewn end-to-end or stapled side-to-side, plus the segments joined.
• Bowel segments involved: specific names, such as ileum to ileum or sigmoid to descending colon. A vague reference to “bowel” won’t support the code.
• Stoma history: why the stoma was created, since payers may ask for it to establish medical necessity.
• Intraoperative findings: the condition of the bowel ends that justified resection, such as scarring, ischemia or stenosis.

If the note describes a colorectal reconnection, code 44626 instead. Auditors spot a 44625 claim that contradicts the note on record review.

Medicare pays CPT 44625 only as an inpatient procedure

CPT 44625 is on the CMS inpatient-only (IPO) list. Medicare won’t pay it when the claim shows an outpatient or ambulatory surgical center (ASC) place of service.

CMS updates the list annually in the Outpatient Prospective Payment System (OPPS) final rule, typically released in early November. CMS has also finalized a three-year phase-out of the IPO list, starting in CY2026. Code 44625 remains listed for CY2026, so check each new rule before you bill.

Practical checks for billing teams:

• Confirm the surgery took place during an inpatient admission before you submit to Medicare.
• With a Medicare Advantage plan, confirm its admission and authorization rules before the surgery date.
• Commercial payers may cover 44625 in an outpatient setting, so verify by payer rather than assuming.
• Look for status indicator C beside 44625 in the current OPPS Addendum B, which marks inpatient-only codes.

Six modifiers cover most 44625 exceptions

CPT code 44625 carries a 90-day global surgical period, so routine post-op care is bundled into the surgical fee. Modifiers flag the exceptions and report services outside that package.

The facility rate sets Medicare’s payment for 44625

Medicare pays CPT code 44625 under the Medicare Physician Fee Schedule (MPFS), using relative value units (RVUs). Because the code is inpatient-only, the facility rate applies. That’s the surgeon’s fee for work in a hospital, not the office-based non-facility rate.

RVUs and the conversion factor change each January 1. The CMS Physician Fee Schedule lookup tool gives national rates. Your geographic practice cost index (GPCI) then adjusts them for your locality. The FastRVU 2026 RVU lookup estimates payment with GPCI adjustments for your Medicare Administrative Contractor region.

Commercial rates for 44625 vary by contract and often run above Medicare. Check the payer contract before you estimate reimbursement on a specific claim.

How a 44625 claim moves from op note to payment

1. The surgeon signs an operative note that names the resection, the segments and the anastomosis.
2. The coder assigns 44625, lists Z43.2 or Z43.3 first and adds the underlying condition.
3. The claim goes out as an 837P professional claim with place of service 21 and any prior authorization number.
4. A clearinghouse checks the format and forwards the claim to the payer.
5. The payer applies global period and inpatient-only rules, then returns an electronic remittance advice (ERA).

Five denials hit CPT 44625 claims most often

CPT code 44625 claims fail in five recurring ways, and each one is preventable. A steady denial management workflow cuts resubmission costs and protects cash flow. Our denial code guide decodes the reason codes payers send back.

1. Outpatient billing for an inpatient-only procedure. Medicare rejects 44625 with an outpatient or ASC place of service. Fix it by confirming the inpatient admission, then refiling with POS 21 (inpatient hospital).
2. No resection in the operative report. Payers downcode to 44620 when the note says “takedown” or “reversal” without confirming excised bowel. Ask the surgeon for an addendum before resubmitting, and use clear resection language from then on.
3. A colorectal anastomosis billed as 44625. A colon-to-rectum join belongs under 44626, and payers catch the mismatch on record review. Recode to 44626 and check the note meets that code’s requirements.
4. Missing modifier 51 on a multi-procedure claim. When 44625 shares a date of service with another surgery, the secondary procedure takes modifier 51. Without modifier 51 and the correct line order, payers may reject or misprice the claim. List 44625 first when it is the primary procedure.
5. No prior authorization. Many Medicare Advantage and commercial plans require prior authorization for major inpatient surgery. Without an approval, the claim is denied whatever the documentation says. Confirm authorization before the surgery date and keep the reference number in the claim file.

Before you submit: A five-point check

• Inpatient admission status is documented for the surgery date.
• The note states that bowel was resected and names the segments.
• The anastomosis does not join colon to rectum.
• Z43.2 or Z43.3 leads the diagnosis list, followed by the underlying condition.
• Modifiers, line order and any prior authorization number are on the claim.

Hold any claim that fails a check until the surgeon adds an addendum. A resubmission costs more time than the review.

Most Medicare Advantage and commercial plans want prior authorization

Original Medicare doesn’t require prior authorization for CPT code 44625. It does require medical necessity, supported by the clinical record, the diagnosis codes and the operative report.

Medicare Advantage plans and most commercial insurers handle 44625 differently. Requirements vary by plan. They may include surgeon notes, imaging of the original indication and evidence the patient is fit for reversal. A clear prior authorization process prevents same-day cancellations caused by missing approvals.

• Contact the insurer well before the scheduled surgery date.
• Send the surgeon’s clinical notes and the proposed diagnosis codes with the request.
• Include the record of the original stoma surgery, such as the prior operative note or discharge summary.
• Keep the approval number and expiry date, and report the number in item 23 of the CMS-1500 claim.

The 90-day global period bundles routine follow-up

CPT code 44625 carries a 90-day global period. Routine post-op care from the day after surgery through day 90 is bundled into the surgical fee. Payers deny bundled visits billed separately, and a pattern of them can draw audit attention.

These services can still be billed separately during the global period:

• Unrelated E/M visits (modifier 24): visits for conditions unrelated to the closure. The diagnosis must differ from the surgical indication.
• New, unrelated surgery (modifier 79): an operation for a separate problem during the global window, documented as unrelated to the closure.
• Return to the OR for a complication (modifier 78): surgery for a complication of the closure, such as an anastomotic leak repair.
• Staged procedures (modifier 58): a procedure planned or anticipated at the original surgery and done during the post-op period.

Z43.2 or Z43.3 leads the diagnosis line on a 44625 claim

Diagnosis codes show why the closure is clinically appropriate, which heads off medical necessity denials. The closure encounter is coded as attention to the stoma, not as stoma status.

Pair Z43.2 or Z43.3 with the condition code that explains why the stoma was created. Z93.2 and Z93.3 are status codes for other encounters. An Excludes1 note on Z93 bars them when the stoma itself needs attention. Verify pairings in the CDC ICD-10-CM coding tool and the annual ICD-10-CM Official Guidelines for Coding and Reporting.

How claims software keeps CPT 44625 claims on track

Many surgical billing teams still build each 44625 claim by hand. They copy codes from the operative note, retype patient details and chase the claim through payer portals.

Pabau, the practice management platform we build, handles that stretch with claims management that pre-fills each claim from the patient record. Coders pick CPT and ICD-10 codes from built-in lookup libraries. Required-field validation then flags a missing entry before the claim leaves.

Pabau integrates with the Claim.MD clearinghouse for electronic claim submission to CMS and US payers. Eligibility checks, claim-status tracking and ERA posting run through the same connection, so your team works from one screen.

Send cleaner enterostomy closure claims

Pabau pre-fills surgical claims from the patient record, checks CPT and ICD-10 codes against built-in libraries and validates required fields. Claims, eligibility checks and ERAs then run through Claim.MD.

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Conclusion

CPT code 44625 stands or falls on one documented fact. The surgeon resected bowel and joined it somewhere other than colon to rectum. Get that into every operative note, and most 44625 denials never happen.

The trade-off is a few minutes up front. A coder who reads the note before coding catches a 44620 or 44626 case early. That beats appealing a downcode months later.

Pabau tracks claim status and posts ERAs through Claim.MD, so a downcoded 44625 claim shows up as soon as the payer responds. Book a demo to see how Pabau moves surgical claims from operative note to payment.

Continue your research

Need guidance on medical billing compliance for surgical procedures? Medical billing compliance covers the documentation and regulatory requirements that protect surgical practices from audit risk.

Want to understand how clearinghouse claims work end-to-end? 837 file submission explains the electronic transaction format used for inpatient surgical claim filing, including field-level requirements.

Looking for clean claim best practices beyond documentation? Superbill creation covers how to structure the charge capture document that feeds accurate CPT and ICD-10 codes into your claim.

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