Monday, June 15, 2015

CPT CODE 44380, 44385 , 44799, 45399


Enteroscopy

A new definition and instructions for reporting antegrade transoral small intestine endoscopy (i.e., enteroscopy) have been added to the section guidelines. Enteroscopy is defined by the most distal segment of small intestine that is examined; coding does not reflect the technology used to perform the examination.

Codes in the 44360 family for enteroscopy, not including ileum (44360–44373), are endoscopic procedures to visualize the esophagus through the jejunum using an antegrade approach. Codes in the 44376 family for enteroscopy, including ileum (44376–44379), are endoscopic procedures to visualize the esophagus through the ileum using an antegrade approach.

If an endoscope cannot be advanced at least 50 cm beyond the pylorus, see the appropriate code in the EGD family (43233, 43235–43259, 43266, 43270). If an endoscope can be passed at least 50 cm beyond pylorus, but only into jejunum, see the appropriate code in the enteroscopy, not including ileum family (44360–44373).

To report retrograde examination of small intestine via anus or colon stoma, use 44799, Unlisted procedure, small intestine.

There were no changes to the language of the individual CPT codes.

Ileoscopy
New codes have been added to the ileoscopy family for transendoscopic balloon dilation and stent placement.

CPT Code Short Description Summary of Changes
44380  Ileoscopy Editorial: “Including collection of specimen(s) by brushing or washing, when performed” replaces “with or without collection of specimen(s).”
44382  Biopsy No change
44381  Balloon dilation Report new code 44381 with modifier 59 for each additional stricture dilated. Not separately reportable with stent placement code 44384 for the same lesion. Use 74360 if fluoroscopic guidance is performed.
44384  Stent placement Code 44383 has been deleted. New code 44384 includes pre- and post-dilation and guide wire passage. Not separately reportable with dilation code 44381. Use 74360 if fluoroscopic guidance is performed.

Pouchoscopy

New section guidelines will instruct users to report pouch endoscopy codes for endoscopic examination of a patient who has undergone resection of colon with ileo-anal anastomosis (e.g., J pouch). Language changes to the pouchoscopy base and biopsy codes are editorial in nature.

CPT Code Short Description Summary of Changes
44385  Pouchoscopy Editorial: Terminology updated to include Kock pouch and ileal reservoir [S or J] as examples. “Including collection of specimen(s) by brushing or washing, when performed” replaces “with or without collection of specimen(s).”
44386  Biopsy No change


Unlisted Procedures
A new code has been developed and one revised to distinguish unlisted procedure of the colon from unlisted procedure of the small intestine and unlisted procedure of the rectum.


CPT Code Short Description Summary of Changes
44799  Unlisted procedure, small intestine Specifies unlisted procedure of small intestine.
45399  Unlisted procedure, colon New code for unlisted procedures of the colon. Note: the CPT Errata indicates code 45399 does not include moderate sedation. The moderate sedation bullseye symbol for code 45399 was placed in the CPT 2015 book in error. 


Billing and Coding Guidelines 

 •Report colonoscopy (45378–45398) for endoscopic examination of a patient who has undergone segmental resection of the colon (eg, hemicolectomy, sigmoid colectomy, low anterior resection).

 •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.

 ** 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. 

** Report ileoscopy through stoma (44380, 44381, 44382, 44384) for endoscopic examination of a patient who has an ileostomy. ** For colonoscopy per rectum, see 45378-45398.



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