Gastroenterology Coding Alert

Question: I’m not sure how to code a fecal microbiota transplant (FMT). We don’t do many of those procedures here. I see preparation codes, but not many instillation codes.

Colorado Subscriber

Answer: The American Medical Association (AMA) released Category III CPT^® code 0780T (Instillation of fecal microbiota suspension via rectal enema into lower gastrointestinal tract), effective Jan. 1, 2023. As you probably know, Category III CPT^® codes are temporary and, therefore, aren’t assigned relative value units (RVUs). This means there is no established payment rate, and reimbursement is at the payer’s discretion. Because of this, reimbursement for FMTs can be tricky. However, there are a couple of other potential coding options that may result in problem-free reimbursement.

For most commercial plans, you’ll use 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen). Unlike 0780T, instillation is not included as a part of this service, so you will code the instillation separately using one of the following depending on method:

• 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure))
• 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed [separate procedure])
• 44799 (Unlisted procedure, small intestine)

Medicare does not recognize 44705, however, so in the event of medical necessity, report HCPCS Level II code G0455 (Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen) for Medicare patients. This code includes any method of instillation. However, it should be noted that physicians and their staff rarely prepare the specimen themselves for FMTs via endoscope or enema.

Note: Reimbursement rules and regulations likely differ among payers, so be sure to contact the patient’s payer with any questions.