Wiki Fecal Transplant - eliminate some confusion

[sfishley]

I am trying to eliminate some confusion I have about coding these cases.

How would you code the procedure below?

Thanks in advance for your help.
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Indications:

Refractory C Diff Colitis

Pre-Procedure:

Clinical History and Physical Exam:

The patient clinical history and physical examination were performed are documented in the patient record.

Consent:

The benefits, risks and alternatives to the procedure were discussed and informed consent was obtained from the patient

Preparation: EKG, pulse, pulse oximetry and blood pressure were monitored throughout the procedure. An intravenous line was inserted.

Medication:

(Refer to the Anesthesia Note)

Rectal Exam:

Normal Rectal Exam

Procedure: The endoscope was passed with ease through the anus under direct visualization; it extended to the cecum, confirmed by appendiceal orifice and ileocecal valve. The scope was withdrawn and the mucosa was carefully examined.

An Olympus model-serial number (PCF-Q180AL-2603597) endoscope was used to perform the procedure.

Findings:

Terminal Ileum: The terminal ileum appeared to be normal.

Colon: Prominent IC valve biopsied. 50 gms of donor stool diluted in 600 CCs saline injected into TI and R colon.

Complications/ Unplanned Events: There were no complications or unplanned events

Estimated Blood Lost: none

Post Procedure Condition: Stable

Summary: Normal terminal ileum, Prominent IC valve biopsied, 50 gms of donor stool diluted in 600 CCs saline injected into TI and R

Procedure codes:

 

[bridgettemartin]

44705/g0455

My understanding is CPT code 44705 is used for the preparation of the fecal microbiota, and can be submitted with the appropriate Colonoscopy code. (CPT instructs to use 44799 for instillation via oro/naso gastric tube.) My provider told me the slurry is prepared in the procedure room just prior to instillation. Since he either mixes it himself, or oversees the nurse mixing it, I feel comfortable billing out 44705. It is my understanding that the donor stool specimen is tested for certain diseases, and that is billed separately.
Medicare does not accept 44705. They have created G0455, which unfortunately encompasses the prep and the instillation of the microbiota.

 

[sfishley]

Thank you