Gastroenterology Coding Alert

Question: Our gastroenterologist used fecal bacteriotherapy as a treatment for a clostridium difficile infection. Which code should we report?

California Subscriber

Answer: The answer may depend on the patient’s insurer. If you’re billing a private payer, you’ll use a combination of two codes: one for the preparation and assessment of the fecal microbiota sample and the other for the instillation into the patient’s gut.

Use code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen) to cover your gastroenterologist’s work developing the microbiota sample that will be instilled in the patient’s digestive tract and for assessing the sample. You’ll also report an additional code, depending on the method your gastroenterologist uses to introduce the fecal sample in the patient’s digestive tract.

When your gastroenterologist uses colonoscopy to introduce the sample, you will report 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)). If the physician instead uses an upper EGD for instillation, you’ll report 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) or 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)) if the specimen is placed beyond 50 cm down past pylorus via a pediatric colonoscope (also known as “push enteroscopy”).

If your patient has Medicare instead of private insurance, keep in mind that CMS will only reimburse for preparation and assessment of a fecal microbiota sample if the sample has been used in the treatment of the patient. Therefore, CMS combines microbiota sample prep and instillation with HCPCS code G0455 (Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen). This is the code you’ll report for this service if you’re treating a Medicare patient.

Note that assessment of the donor specimen involves the many infection and other tests run on a potential donor stool; this does not refer to simply thawing out a commercial sample before instilling it through a scope into the patient. Most typically then, for almost all situations where fecal microbiome transplant (FMT) is performed, the gastroenterologist just bills for the type of scope procedure performed to place the specimen.