Sunday, July 31, 2016

Colonoscopy with stool transplant CPT code 44705


There is no specific code to bill Colonoscopy with Stool transplant. We can use Fecal Microbiita Transplant code instead of Colonoscopy with stoll transplant code.

Coding and billing FMT (Fecal Microbiota Transplant) donor and recipient procedures for commercial payors  Report an appropriate level E/M code for the specimen collection.

Report the appropriate laboratory testing and ICD-9/10 codes for testing the donor for infectious pathogens to rule out unsuitable specimens.

Do not report 44705 if the specimen is unsuitable for transplantation.

If the specimen is suitable for transplantation then code 44705 can be reported. Unless otherwise specified by the payor, the preparation of the donor specimen is typically covered by the recipient’s insurance.

44705, Preparation of fecal microbiota for instillation, including assessment of donor specimen

The instillation of microbiota is separately reported. For instillation of microbiota by oro-nasogastric tube or enema, use 44799. For instillation via esophagogastroduodenoscopy (EGD) or colonoscopy, use the appropriate CPT code for upper gastrointestinal endoscopy or colonoscopy.

Do not report 44705 in conjunction with 74283 (Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (e.g., meconium ileus)).

NOTE: Code 44705 has a Medicare Physician Fee Schedule procedure status indicator of I (Not valid for Medicare purposes) and should not be used to report FMT for Medicare beneficiaries. See Coding and billing FMT recipient procedures for Medicare beneficiaries below.


Coding and billing FMT recipient procedures for Medicare beneficiaries

G0455, Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen

HCPCS code G0455 includes the work of preparation AND instillation of the microbiota. Medicare does not pay a separate fee for the installation of the microbiota by oro-nasogastric tube, enema, or by upper or lower endoscopy.

Only the donor specimen that is ultimately used for the treatment of the beneficiary can be billed in conjunction with the instillation. Medicare does not cover the costs of screening of the donor specimen, thus beneficiaries should be advised of the cost of screening, which they may be at risk of paying for out-of-pocket.  This may require the physician to provide an Advanced Beneficiary Notice of Non-coverage (ABN) Form to the donor and recipient beneficiary.


CPT Codes 44705

Preparation of fecal microbiota for instillation, including assessment of donor specimen

HCPCS Codes G0455

Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen


Current Policy Statement

Fecal bacteriotherapy or fecal microbiota transplant (FMT) may be considered medically necessary as a treatment for recurrent or relapsing Clostridium Difficile infection (CDI) as indicated by a positive C. Difficile toxin stool test and defined as one of the following:

** At least 3 episodes of mild to moderate CDI and failure of a 6-8 week taper with vancomycin with or without an alternative antibiotic (e.g., rifaximin, nitazoxanide), or

** At least two episodes of severe CDI resulting in hospitalization and associated significant morbidity, or

** Moderate CDI not responding to standard therapy (vancomycin) for at least a week, or

** Severe fulminant C difficile colitis with no response to standard therapy after 48 hour

ICD-9 Codes
008.45  Intestinal infections due to clostridium difficile

ICD-10 Codes
AØ4.7 Enterocolitis due to Clostridium difficile

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