Gastroenterology Coding Alert

Fecal bacteriotherapy (also known by other names such as stool transplant, fecal transplant, fecal microbiota transplant, and human probiotic infusion) is a covered benefit under the following circumstances):

·         The patient is suffering from recurrent episodes of C. difficile infections wherein the patient has had at least three bouts of mild to moderate infection with failure of medication management using vancomycin or other medications;

·         The patient has suffered at least two bouts of severe infection that needed hospitalization;

·         The patient is suffering from moderate infection not responding to medication management with vancomycin or other  medications continuously for the period of a week;

·         The patient has severe infection for the past 48 hours and is not responding to medication management using vancomycin or other medications.

To indicate the medical necessity for performing fecal bacteriotherapy, you will have to support documentation using the ICD-9 code 008.45 (Intestinal infection due to clostridium difficile).