General Surgery Coding Alert

Question: How should we bill for a procedure when our surgeon transplants processed donor fecal material during an endoscopy, instilling 100 ml into the duodenum and jejunum?

Iowa Subscriber

Answer: The correct code for the enteroscopy is 44360 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed [separate procedure]).

For the Fecal Microbiota Transplant (FMT), CPT^® now provides code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen) to describe part of the service. You should bill that code only if your clinician performs and documents the specimen preparation step.

Medicare difference: Code 44705 has a Medicare Physician Fee Schedule procedure status indicator of "I" (Not valid for Medicare purposes), so you should not report this code for FMT for Medicare beneficiaries

Instead, for Medicare beneficiaries, you should report HCPCS code G0455 (Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen).

Code G0455 includes both preparation and instillation work, by any method. That means Medicare does not pay a separate fee for the installation of the microbiota by oro-nasogastric tube, enema, or even by upper or lower endoscopy. When you bill G0455, you shouldn't also bill 44705 or the endoscopy code, such as 44360.

Pay the price: For Medicare beneficiaries, you can expect $75.73 in G0455 pay compared to $151.81 for 44360 (facility national adjusted amount, conversion factor 35.8887). Assuming that other payers compensate similar to the Physician Fee Schedule for 44360, plus allow an amount for 44705, you can see that you'll get much less pay for the procedure for a Medicare beneficiary.