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Intraoperstive Small Bowel Endoscopy

kernodle Posted Fri 31st of May, 2013 15:07:52 PM

General surgeon will be performing partial small bowel resection. During procedure gastroenterologist will perform a push-through small bowel endoscopy. Would you report the gastro portion as '44799' and compare to '44380' for value?

Deb Hughes

SuperCoder Answered Mon 03rd of June, 2013 22:09:07 PM

If the physician intends to perform an examination of the proximal small intestine as described in the definition of the small bowel enteroscopy CPT code, a pediatric colonoscope or a dedicated push enteroscope is required. If your doctor is using a standard upper endoscope, he plans on performing an esophagogastroduodenoscopy (EGD), not a small bowel endoscopy. By entering the third duodenum, he is only conducting a thorough EGD.

You should report the intended EGD with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). When a clinical indication exists to examine the small intestine that would stand up to an audit for "appropriate and necessary" criteria, use 44360 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). Common indications for small bowel enteroscopy include obscure GI bleeding, abnormal UGI series, and chronic diarrhea.

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