Dawna Posted Thu 31st of January, 2013 19:59:47 PM
We are having a heated discussion about the use of the new cpt code 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen.)
Some are saying that this code would be reported by the GI provider at the time the specimen in placed in the gi tract (either via Colonoscopy or EGD) It looks to me like it is for preparation only.
Could you please give an example of how/when this code should be used, and who(gi doc, pathologist, etc) will be reporting it?
SuperCoder Answered Thu 31st of January, 2013 20:09:41 PM
Add 44705 to Your Coding Arsenal
"We had previously covered that in 2013 we will see an end to your reporting fecal bacteriotherapy with an unlisted code." You can now update your list of codes with a code for reporting fecal bacteriotherapy, also known as a fecal intestinal transplant (FIT), when your gastroenterologist performs it. So, if your gastroenterologist performs a stool transplant, you will report part of this service with 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen).
In addition to the preparation of the donor specimen (reported using 44705), you will have to use the appropriate code for the instillation of the specimen in the gut. Depending on choice, your gastroenterologist might perform a colonoscopy, EGD, rectal enema or a nasogastric tube to instill the specimen. For example, if your gastroenterologist uses an EGD to instill the specimen, you should report 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]) along with 44705 for the preparation of the specimen.
Example: Your gastroenterologist decides to perform stool transplant on a patient suffering from C. difficile infection not responding to antibiotic treatment and other forms of treatment. He decides to use a sample from the patient's spouse for the transplant. He orders a thorough assessment of the stool sample to check for communicable diseases and other parasitic infections. He then prepares a sample for instilling in the patient's gut.
Your gastroenterologist then performs a colonoscopy to instill the stool sample. You will report the services using 44705 for the preparation and assessment of the stool sample and 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) for the colonoscopy he performed to place the stool sample in the patient's gut.
Dawna Posted Fri 01st of February, 2013 18:08:44 PM
So will I need to be looking for additional documentation from my GI docs stating that they personally prepared the specimen? (Since that could be performed by someone other than the provider performing the instillation)
Normally when a fecal transplant is performed, the only statement that is documented is "120 ccs of fecal biotherapy was administred to the jejunum (or colon)". There is never any mention of pre-procedure preparation of the sample. I would like to give my providers documentation guidelines on what I will be looking for in order to bill the service.
Thank you so much for your help!