Sunday, April 24, 2011

colonoscopy CPT code - 44388, 44385, 44389, 44390, 44392 -45380 - 45392 - when to use

cpt code and description

44390 - Colonoscopy through stoma; with removal of foreign body(s) - average fee amount-$450 - $460

44388 - Colonoscopy through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

44389 - Colonoscopy through stoma; with biopsy, single or multiple


44391 - Colonoscopy through stoma; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

44392 - Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery


Colonoscopy is a visual examination of the lining of the large intestine with a rigid or flexible video or fiberoptic endoscope. The colonoscope is inserted anally or through a stoma and is advanced through the large intestine to the ileocecal valve under direct vision using the scope’s optical system.

Indications

  • Evaluation of an abnormality on barium enema that is likely to be clinically significant, such as a filling defect or stricture.
  • Evaluation of unexplained gastrointestinal bleeding:
    • Hematochezia.
    • Melena of unknown origin.
    • Presence of fecal occult blood.
  • Unexplained iron deficiency anemia.
  • Chronic inflammatory bowel disease of the colon if more precise diagnosis or determination of the extent of activity of disease will influence immediate management.
  • Clinically significant diarrhea of unexplained origin.
  • Intraoperative identification of the site of a lesion that cannot be detected by palpation or gross inspection at surgery (e.g., polypectomy site or location of a bleeding source).
  • Evaluation of acute colonic ischemia/ischemic bowel disease.
  • Evaluation of patient with Streptococcus bovis endocarditis.
  • Treatment of bleeding from such lesions as vascular anomalies, ulceration and neoplasia.
  • Removal of foreign body.
  • Excision of colonic polyps.
  • Decompression of pseudo-obstruction of the colon (Ogilvie’s syndrome).
  • Treatment of sigmoid volvulus.
  • Suspected disease of terminal ileum.

Limitations
Colonoscopy is generally not covered for treating the following, and records must have additional documentation indicating the medical necessity of the procedure and submitted for review as requested (do not submit with claim):
  • Chronic, stable, irritable bowel syndrome or chronic abdominal pain. There are unusual exceptions in which the colonoscopy may be done once to rule out organic disease, especially if symptoms are unresponsive to therapy.
  • Acute limited diarrhea.
  • Hemorrhoids.
  • Metastatic adenocarcinoma of unknown primary site in the absence of colonic symptoms when it will not influence management.
  • Routine follow-up of inflammatory bowel disease (except for cancer surveillance in chronic ulcerative colitis).
  • Routine examination of the colon in patients about to undergo elective abdominal surgery for non-colonic disease.
  • Upper GI bleeding or melena with a demonstrated upper GI source.


Contraindications
Colonoscopy is not indicated for:
  • Fulminant colitis.
  • Possible perforated viscus.


 Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:

  • Safe and effective.
  • Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
  • Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
    • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
    • Furnished in a setting appropriate to the patient’s medical needs and condition.
    • Ordered and furnished by qualified personnel.
    • One that meets, but does not exceed, the patient’s medical need.
    • At least as beneficial as an existing and available medically appropriate alternative.

Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 18X, 21X, 71X, 73X, 77X, 83X, 85X
Bill Type Note (above): Code 73X end-dated for Medicare use March 31, 2010; code 77X effective for dates of service on or after April 1, 2010.

CPT/HCPCS Codes


44388© Colon endoscopy
44389© Colonoscopy with biopsy
44390© Colonoscopy for foreign body
44391© Colonoscopy for bleeding
44392© Colonoscopy & polypectomy
44393© Colonoscopy, lesion removal
44394© Colonoscopy w/snare
44397© Colonoscopy w/stent
45355© Surgical colonoscopy
45378© Diagnostic colonoscopy
45379© Colonoscopy w/fb removal
45380© Colonoscopy and biopsy
45381© Colonoscope, submucous inj
45382© Colonoscopy/control bleeding
45383© Lesion removal colonoscopy
45384© Lesion remove colonoscopy
45385© Lesion removal colonoscopy
45386© Colonoscope dilate stricture
45387© Colonoscopy w/stent
45391© Colonoscopy w/endoscope us
45392© Colonoscopy w/endoscopic fnb



Billing and Coding Guidelines Colonoscopy

The definition of a colonoscopy examination is now specifically described in CPT as the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis.

X When performing a diagnostic or screening procedure on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, report 45378 (colonoscopy) or 44388 (colonoscopy through stoma) with modifier 53 and provide appropriate documentation.

X If a therapeutic examination colonoscopy is performed and does not reach the cecum or colon-small intestine anastomosis, report the appropriate therapeutic colonoscopy code with modifier 52 and provide appropriate documentation.

New codes for the colonoscopy family include endoscopic mucosal resection (EMR), band ligation and decompression for pathologic distention. Revised codes address appropriate reporting of ablation and stent placement. 



CPT 2015 Code Description CMS CY 2015 Crosswalk

44403 Colonoscopy through stoma w/EMR 44388, G6021

44404 C-stoma w/submucosal injection 44388, G6021

44405 C-stoma w/dilation 44388, G6021

44406 C-stoma w/ultrasound 44388, G6021

44407 C-stoma w/US-guided FNA 44388, G6021

44408 C-stoma w/decompression 44388, G6021


Colonoscopy through Stoma

Colonoscopy through stoma has been specifically defined in CPT as the examination of the colon, from the colostomy stoma to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis. When performing a diagnostic or screening colonoscopy through stoma on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, report 44388 with modifier 53 and provide appropriate documentation. If a therapeutic colonoscopy is performed and does not reach the cecum or colon-small intestine anastomosis, report the appropriate therapeutic colonoscopy through stoma code with modifier 52 and provide appropriate documentation.


44388 Colonoscopy through stoma Colonoscopy through stoma is the examination of the remaining colon to the cecum or colon-small intestine anastomosis, and may include the examination of the terminal ileum or small intestine proximal to an anastomosis. When performing a diagnostic or screening exam, report 44388 with modifier 53 if unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances and provide appropriate documentation.



•For colonoscopy through stoma, see 44388–44408. Report proctosigmoidoscopy (45300–45327), flexible sigmoidoscopy (45330–45347), or anoscopy (46600, 46604, 46606, 46608, 46610, 46611, 46612, 46614, 46615), as appropriate for endoscopic examination of the defunctionalized rectum or distal colon in a patient who has undergone colectomy, in addition to colonoscopy through stoma (44388–44408) or ileoscopy through stoma (44380, 44381, 44382, 44384) if appropriate. 

X Colonoscopy procedures:

• When performing a diagnostic or screening endoscopic procedure on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, report 45378 (colonoscopy) or 44388 (colonoscopy through stoma) with modifier 53 and provide appropriate documentation.


• If a therapeutic colonoscopy (44389-44407, 45379, 45380, 45381, 45382, 45384, 45388,45398) is performed and does not reach the cecum or colon-small intestine anastomosis, report the appropriate therapeutic colonoscopy code with modifier 52 and provide appropriate documentation. 




ICD-10 CODE DESCRIPTION

A04.5 Campylobacter enteritis
A04.7 Enterocolitis due to Clostridium difficile
A06.9 Amebiasis, unspecified
A09 Infectious gastroenteritis and colitis, unspecified
A18.31 - A18.39 - Opens in a new window Tuberculous peritonitis - Retroperitoneal tuberculosis
A18.83 Tuberculosis of digestive tract organs, not elsewhere classified
C18.0 - C21.8 - Opens in a new window Malignant neoplasm of cecum - Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C77.2 Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes
C78.5 Secondary malignant neoplasm of large intestine and rectum
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
C80.0 Disseminated malignant neoplasm, unspecified
C80.2 Malignant neoplasm associated with transplanted organ
D01.0 - D01.3 - Opens in a new window Carcinoma in situ of colon - Carcinoma in situ of anus and anal canal
D12.0 - D12.9 - Opens in a new window Benign neoplasm of cecum - Benign neoplasm of anus and anal canal
D37.1 - D37.5 - Opens in a new window Neoplasm of uncertain behavior of stomach - Neoplasm of uncertain behavior of rectum
D37.8 - D37.9 - Opens in a new window Neoplasm of uncertain behavior of other specified digestive organs - Neoplasm of uncertain behavior of digestive organ, unspecified
D50.0 Iron deficiency anemia secondary to blood loss (chronic)
D50.9 Iron deficiency anemia, unspecified
I33.0 Acute and subacute infective endocarditis
I78.0 Hereditary hemorrhagic telangiectasia
K50.00 - K56.2 - Opens in a new window Crohn's disease of small intestine without complications - Volvulus
K56.5 - K56.7 - Opens in a new window Intestinal adhesions [bands] with obstruction (postprocedural) (postinfection) - Ileus, unspecified
K57.20 - K57.53 - Opens in a new window Diverticulitis of large intestine with perforation and abscess without bleeding - Diverticulitis of both small and large intestine without perforation or abscess with bleeding
K58.0 - K59.2 - Opens in a new window Irritable bowel syndrome with diarrhea - Neurogenic bowel, not elsewhere classified
K59.8 Other specified functional intestinal disorders
K62.0 - K62.7 - Opens in a new window Anal polyp - Radiation proctitis
K62.82 - K62.9 - Opens in a new window Dysplasia of anus - Disease of anus and rectum, unspecified
K63.1 - K63.89 - Opens in a new window Perforation of intestine (nontraumatic) - Other specified diseases of intestine
K91.850 - K91.858 - Opens in a new window Pouchitis - Other complications of intestinal pouch
K91.89 Other postprocedural complications and disorders of digestive system
K92.1 - K92.2 - Opens in a new window Melena - Gastrointestinal hemorrhage, unspecified
K92.89 Other specified diseases of the digestive system
Q85.8 - Q85.9 - Opens in a new window Other phakomatoses, not elsewhere classified - Phakomatosis, unspecified
R10.0 - R10.33 - Opens in a new window Acute abdomen - Periumbilical pain
R10.83 - R10.9 - Opens in a new window Colic - Unspecified abdominal pain
R11.13 Vomiting of fecal matter
R19.4 - R19.5 - Opens in a new window Change in bowel habit - Other fecal abnormalities
R19.7 - R19.8 - Opens in a new window Diarrhea, unspecified - Other specified symptoms and signs involving the digestive system and abdomen
R93.3 Abnormal findings on diagnostic imaging of other parts of digestive tract
T18.4XXA Foreign body in colon, initial encounter
Z85.00 - Z85.01 - Opens in a new window Personal history of malignant neoplasm of unspecified digestive organ - Personal history of malignant neoplasm of esophagus
Z85.028 Personal history of other malignant neoplasm of stomach
Z85.038 Personal history of other malignant neoplasm of large intestine
Z85.048 - Z85.05 - Opens in a new window Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus - Personal history of malignant neoplasm of liver
Z86.010 Personal history of colonic polyps
Z87.19 Personal history of other diseases of the digestive system
Showing 1 to 46 of 46 entries in Group 1
FirstPrevCurrently Selected1NextLast



ICD-9-CM Codes That Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45355, 45378, 45379, 45380, 45381, 45382, 45383, 45384, 45385, 45386, 45387, 45391 and 45392:

Covered for:
006.9
Amebiasis unspecified
008.04
Intestinal infection due to enterohemorrhagic e. Coli
008.43
Intestinal infection due to campylobacter
008.45
Intestinal infection due to clostridium difficile
009.0–009.3
Ill-defined intestinal infections
014.00–014.06
Tuberculous peritonitis
014.80–014.86
Tuberculosis of intestines, peritoneum, and mesenteric glands – other
041.02
Streptococcus – Group B
041.04
Streptococcus – Group D [enterococcus]
153.0–153.9
Malignant neoplasm of colon
154.0–154.3
Malignant neoplasm of rectosigmoid junction
154.8
Malignant neoplasm of other sites of rectum rectosigmoid junction and anus
195.3
Malignant neoplasm of pelvis
196.2
Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes
197.5–197.7
Secondary malignant neoplasm of respiratory and digestive systems
199.0
Disseminated malignant neoplasm
211.3–211.4
Benign neoplasm of other parts of digestive system
230.3–230.6
Carcinoma in situ of digestive organs
235.2
Neoplasm of uncertain behavior of stomach intestines and rectum
235.5
Neoplasm of uncertain behavior of other and unspecified digestive organs
280.0
Iron deficiency anemia secondary to blood loss (chronic)
280.9
Iron deficiency anemia unspecified
285.1
Acute posthemorrhagic anemia
421.0
Acute and subacute bacterial endocarditis
448.0
Hereditary hemorrhagic telangiectasia
555.0–555.2
Regional enteritis
555.9
Regional enteritis of unspecified site
556.0–556.6
Ulcerative colitis
556.8–556.9
Ulcerative colitis
557.0–557.1
Vascular insufficiency of intestine
557.9
Unspecified vascular insufficiency of intestine
558.1–558.3
Other and unspecified noninfectious gastroenteritis and colitis
558.41–558.42
Eosinophilic gastroenteritis and colitis
558.9
Other and unspecified noninfectious gastroenteritis and colitis
560.0
Intussusception
560.1–560.2
Intestinal obstruction without mention of hernia
560.32
Fecal Impaction
560.81
Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection)
560.89
Other specified intestinal obstruction
560.9
Unspecified intestinal obstruction
562.10–562.13
Diverticulitis of colon
564.4–564.5
Functional digestive disorders not elsewhere classified
564.7
Megacolon other than hirschsprung’s
564.81
Neurogenic bowel
564.89
Other functional disorders of intestine
569.0
Anal and rectal polyp
569.3
Hemorrhage of rectum and anus
569.41
Ulcer of anus and rectum
569.43
Anal sphincter tear (healed) (old)
569.49
Other specified disorders of rectum and anus
569.71
Pouchitis
569.79
Other complications of intestinal pouch
569.81–569.87
Other specified disorders of intestine
569.89
Other specified disorders of intestine
578.1
Blood in stool
578.9
Hemorrhage of gastrointestinal tract unspecified
701.2
Acquired acanthosis nigricans
759.6
Other congenital hamartoses not elsewhere classified
787.60787.63
Incontinence of feces
787.91
Diarrhea
787.99
Other symptoms involving digestive system
789.01–789.07
Abdominal pain
789.09
Abdominal pain, other specified site
Note:
Use 789.01–789.07* and 789.09* to indicate only colonic pain or abdominal pain of suspected colonic origin.
792.1
Nonspecific abnormal findings in stool contents
793.4
Nonspecific (abnormal) findings on radiological and other examination of gastrointestinal tract
936
Foreign body in intestine and colon
V10.00
Personal history of malignant neoplasm of unspecified site in gastrointestinal tract
V10.03
Personal history of malignant neoplasm of esophagus
V10.04
Personal history of malignant neoplasm of stomach
V10.05
Personal history of malignant neoplasm of large intestine
V10.06
Personal history of malignant neoplasm of rectum rectosigmoid junction and anus
V10.07
Personal history of malignant neoplasm of liver
V12.70
Personal history of unspecified digestive disease
V12.72
Personal history of colonic polyps
V72.83
Other specified pre-operative examination
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.

1 comment:

  1. if barium enema is admistered through colostomy do i still charge 74270?

    ReplyDelete

Most read colonoscopy CPT codes