Hello- I have a physician who just performed a "colonoscopy with over the scope padlock placement (to close the fistula) with anesthesia per MD scope clip padlock". ICD 10 code is k63.2- fistula of intestine. Fistulous process identified at 30 cms in the sigmoid, india ink injected gently via the cutaneous opening. The padlock was placed over the scope and the scope was advanced to the site. The tissue was suctioned and device deployed.

I am wondering which CPT code to use? The manufacturer of the padlock (US Endoscopy) suggested colon with control of bleed, which I do not agree with as there is no mention of bleeding anywhere? I know I can bill with colon with injection, but I was looking for something additional for the padlock placement, as this is the first we have done of this type of procedure? I found 44650, closure of enteroenteric or enterocolic fistula, but Medicare and Excellus fee schedule is rather high, and I want to be sure this is appropriate? Any help is greatly appreciated!! Thanks!