Medicare Procedure Code 44376

cpt 44376

44376 - Small Bowel Endoscopy

Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

Esophagogastroduodenoscopy (EGD) with closed biopsy

ICD9 code 45.16

CPT codes 43235, 43238, 43239, 43242, 44360, 44361, 44376, and 44377

Digestive System

Comment: Two commenters proposed the following codes for addition to the ASC list:

CPT Code Description

43030 Cricopharyngeal myotomy.

43830 Gastrostomy, temporary (tube, rubber or plastic) (separate procedure).

Response: CPT code 43030 is performed 79 percent of the time on an inpatient basis, and CPT 43830 is performed 90 percent of the time on an inpatient basis. There is concern about complications with these procedures, and both also require a 23-hour observation period before discharge.

They are therefore not appropriate to the ASC list.

Comment: Commenters proposed adding the following 19 gastrointestinal endoscopy codes that were new CPT codes January 1, 1994: CPT codes 43205, 43216, 43244, 43248, 43250, 43259, 43261, 43458, 44365, 44376, 44377, 44378, 44394, 44500, 45308, 45309, 45338, 45339, and 45384.

Some of the codes involved editorial changes of existing CPT procedures, and some were new CPT procedures.

Response: We have added 12 of these 19 gastrointestinal codes to the ASC list by our manual instructions. They are CPT codes 43216, 43248, 43250, 43261, 43458, 43465, 44394, 45308, 45309, 45338, 45339, and 45384. These 12 CPT codes with their descriptions are listed in Addendum C, part 6, at the end of this notice.

We were able to cross-refer CPT codes deleted from our ASC list (which were identified in Appendix B of the 1994 CPT, a summary of additions, deletions, and revisions applicable to CPT 1994 codes) to these 12 codes. These codes were replacement codes to codes previously on the ASC list. They were cross-referred from existing codes in the 1994 CPT and have been added to the list by our manual instructions.

With this notice, we are also adding from Appendix B of the CPT another code that meets our criteria, CPT code 43259 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/ or jejunum as appropriate; with endoscopic ultrasound examination).

We are not, however, adding CPT codes 43205 (Esophagoscopy, rigid or flexible; with band ligation of esophageal varices) and 43244 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or gastric varices) because the treatment of varices risks complications of severe, sudden bleeding, which may require an immediate blood transfusion or the introduction of a special tube to control the bleeding. These remedies would not necessarily be available as quickly in the ASC setting.

If complications develop, the patient might require airevacuation to the hospital setting. Also, the medical community does not fully accept the use of band ligation in the treatment of varices because its success and comparison to the standard treatment is yet to be completed. We are not adding the following CPT codes to the ASC list:

CPT Code Description

44376 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure).

44378 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding, any method.

44500 Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure).

These procedures require that an endoscopy tube be passed through the gastrointestinal system while the patient waits 4 to 6 hours before the physician performs the endoscopic study.

The patient would need to be in the ASC from 6 to 10 hours. We believe that this extended time period for the procedure exceeds the spirit, if not the letter, of the regulations set forth at § 416.65(b), which establish 5 1/2 hours as a maximum procedure/recovery time.

In conclusion, our medical consultants have determined that CPT codes 43205, 53244, 44376, 44378, and 44500 are not appropriate for Medicare patients in the ASC setting.

Comment: Commenters proposed adding CPT code 45330 (flexible sigmoidoscopy) to the ASC list.

Response: This procedure is performed 73 percent of the time in the physician’s office and is appropriate to that setting. Therefore, it does not meet the criteria for the ASC list and will not be added.

Enteroscopy to Ileum 44376- 44382

44376 Endoscopy, Small Intestine ‐ enteroscopy beyond second portion of duodenum, including ileum; diagnostic, with or without collection of specifmen(s) by brushing or washing, (separate procedure)

Digestive System Endoscopy – Small Intestines Editorial Directive

• Antegrade transoral small intestinal endoscopy(enteroscopy) is defined by the most distal segment of small intestine that is examined.

• 44360-44373 – Enteroscopy - esophagus through jejunum, antegrade

• 44376-44379 – Enteroscopy - esophagus through the ileum, antegrade approach

Multiple Surgical Procedures Reduction List for Professionals

The following table applies to Tufts Health Plan commercial contracted providers. The table below consists of CPT and HCPCS procedure codes that will be subject to a multiple surgical procedure reduction. The procedure codes contained within this table will be accepted by Tufts Health Plan and may have an impact on reimbursement. The absence or presence of a procedure code is not an indication and/or guarantee of coverage and or payment.

CPT/HCPCS Procedure Code - 44376