Gastroenterology Coding Alert

Question: Our general surgeon recently performed a partial small bowel resection. During the procedure our gastroenterologist performed a push-through small bowel endoscopy. Would you report the gastro portion as ‘44799’ and compare to ‘44380’ for value?

California Subscriber

Answer: If your gastroenterologist intends to perform an examination of the proximal small intestine as described in the definition of the small bowel enteroscopy CPT^® code, a pediatric colonoscope or a dedicated push enteroscope is required. If your doctor is using a standard upper endoscope, he plans on performing an esophagogastroduodenoscopy (EGD), not a small bowel endoscopy. By entering the duodenum, he is only conducting a thorough EGD.

You should report the intended EGD with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). When a clinical indication exists to examine the small intestine that would stand up to an audit for “appropriate and necessary” criteria, use 44360 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

Since there are specific CPT^® codes to describe the procedure that your gastroenterologist performed, you’ll have to report these codes rather than resorting to 44799 (Unlisted procedure, intestine) for the procedure. You’ll use 44799 only if there are no other CPT^® codes to specifically describe a procedure that your gastroenterologist performed.