Monday, April 27, 2015

Colonoscopy through Stoma CPT codes 44388, 44389, 44391, 44401



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.

New codes for the colonoscopy through stoma family include endoscopic mucosal resection, submucosal injection, balloon dilation, EUS, EUS with FNA, and decompression for pathologic distention. Revised codes address appropriate reporting of ablation and stent placement.

CPT Code Short Description Summary of Changes
Guidelines New definition. Colonoscopy through stoma is now defined 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 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.
44389 Biopsy Not separately reportable with EMR code 44403 for the
same lesion.
44390 Foreign body(s) removal “Foreign body(s)” replaces “foreign body.”
44391 Control of bleeding “Any method” replaces previous examples. Not separately reportable with injection described by 44404 for same lesion.
44392 Hot biopsy Bipolar cautery was deleted as an example.
44401 Ablation Code 44393 has been deleted. New code 44401 includes
balloon dilation, guide wire insertion and ablation. Not
separately reportable with dilation code 44405 for the
same lesion.
44394 Snare Not separately reportable with endoscopic mucosal resection described by 44403 for the same lesion.
44402 Stent placement Code 44397 has been deleted. New code 44402 includes pre- and post-dilation and guide wire passage. Not separately reportable with dilation code 44405. Use 74360 if fluoroscopic guidance is performed.
44403 Endoscopic mucosal
resection (EMR)
New code 44403 is not separately reportable with biopsy, submucosal injection or snare described by 44389, 44394, 44404 for the same lesion.
44404 Submucosal injection New code 44404 is not separately reportable with endoscopic mucosal resection or control of bleeding described by 44391, 44403 for the same lesion.
44405 Balloon dilation New code 44405 for transendoscopic balloon dilation. Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Not separately reportable with ablation or stent placement described by 44401, 44402. Use 74360 if fluoroscopic guidance is performed.
44406 Endoscopic ultrasound New code 44406 is not separately reportable with EUS FNA code 44407 or radiologic ultrasound code 76975.
Report only once per session.
44407 Endoscopic ultrasound (EUS)
with FNA
New code 44407 is not separately reportable with EUS code 44406 or radiologic ultrasound codes 76942 and 76975. Report only once per session.
44408 Decompression New code 44408 for decompression for pathologic distention, such as volvulus or megacolon. Includes placement of decompression tube when performed.
Report only once per session.

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