Our facility is doing fecal transplants but they are inserting it with an NG tube. Any ideas of how to code? In looking around it's kind of looking like 44799, but then what price do you use or G0455. Thoughts?
From what I understand, G0455 is for any method. Under 44705 in the CPT book, it directs you to use 44799 for oro-nasogastric tube or enema. 44705 includes the assessment of the donor specimen. I also understand there to be separate codes the lab uses to test the donor.
There is still some question, however, as to who gets to report G0455. Medicare states G0455 can only be reported once, and only if the transplant takes place. So, what happens if one provider assesses the patient and orders the fecal transplant and another provider prepares the specimen and instills it?
I've pasted an excerpt from a letter drafted to CMS from the AGA and ASGE.
"Referring to the preparation of the microbiota, there is extensive physician work involved in determining whether a patient is a suitable candidate for fecal donation. This preparation work must take into account recent antibiotic use, travel, transmissible pathogens, and immunodeficiency disease that relate to the potential donor. Once the microbiota is prepared, the microbiota then needs to be instilled. There may be occasions where the work related to instillation of the microbiota may need to be performed by a second health professional, such as a gastroenterologist or surgeon, where clinical circumstances dictate that upper or lower endoscopy is required to instill the fecal donation (e.g. patient who is unable to retain a retention enema). In instances where the preparation is performed by one healthcare professional (Infectious Disease, Primary Care) and the installation by another (Gastroenterology, Surgeon), by bundling the payment for the preparation and installation, this results in a situation where one physician will receive payment for his/her services as well as for those services provided by the other physician."
