Gastroenterology Coding Alert

Answer: The CPT® code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen) was intended to be used for the preparation of the fecal microbiota specimen, and an appropriate diagnostic endoscopy or colonoscopy code was used for instillation of the sample into the GI tract.

 

In the Physician Fee Schedule Final (PFS) Rule for fiscal year (FY) 2013, CMS stated, “Within Medicare, payment for the preparation of the donor specimen would only be made if the specimen is ultimately used for the treatment of a beneficiary as Medicare is not authorized to pay for any costs not directly related to the diagnosis and treatment of a beneficiary. Because of this policy, we believe it is appropriate to bundle the preparation and instillation into one payable HCPCS code.”

 

As 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, CMS has combined both the microbiota sample prep and instillation in the HCPCS code, G0455 (Preparation with instillation of fecal microbiota by any method, including assessment of donor specimen). So, you will only report this code and not report any additional code for the placement of the specimen.

 

CMS also did not accept the RUC recommendation RVU for 44705 and instead created the HCPCS code G0455. Now, irrespective of whether the payer is Medicare or any commercial payer, you will need to report G0455 and not 44705 along with another code for instillation of the sample.