CPT® Code 44100

Official Description

Biopsy of intestine by capsule, tube, peroral (1 or more specimens)

Common Language Description

The procedure described by CPT® Code 44100 involves a biopsy of the intestine using a specialized capsule and tube, which is performed perorally, meaning it is conducted through the mouth. This technique allows the physician to obtain one or more tissue specimens from the intestine, specifically targeting areas such as the jejunum and duodenum. The process begins with the insertion of a capsule attached to a flexible tube into the patient's mouth, which the patient is then instructed to swallow. Once the capsule and tube reach the stomach, the patient is guided to drink water and change positions as necessary to facilitate the passage of the capsule and tube into the jejunum, the middle section of the small intestine. Alternatively, the procedure may involve the direct passage of a flexible tube through the mouth into the stomach, which is then advanced through the pylorus (the opening from the stomach into the small intestine) and into the duodenum (the first part of the small intestine). The physician manipulates the tube to reach the duodenojejunal junction, where biopsies are typically taken from the jejunum. If required, the tube can be advanced further to obtain additional specimens. The biopsy capsule is then activated to collect tissue samples from the jejunum, followed by the withdrawal of the tube into the duodenum to obtain further biopsies. After the procedure, the tube is completely withdrawn, and the collected specimens are prepared and sent to a laboratory for evaluation, which is reported separately. This method is essential for diagnosing various gastrointestinal conditions and allows for targeted sampling of intestinal tissue for further analysis.

1. Indications

The biopsy of the intestine by capsule and tube is indicated for various gastrointestinal conditions where tissue sampling is necessary for diagnosis. The following are specific indications for this procedure:

Suspicion of Intestinal Disorders The procedure is performed when there is a clinical suspicion of conditions such as celiac disease, Crohn's disease, or other inflammatory bowel diseases that may require histological evaluation.
Unexplained Gastrointestinal Symptoms Patients presenting with unexplained gastrointestinal symptoms, such as chronic diarrhea, abdominal pain, or weight loss, may be candidates for this biopsy to identify underlying pathologies.
Evaluation of Tumors The procedure may be indicated for the evaluation of suspected tumors or lesions in the small intestine, allowing for the collection of tissue samples for further analysis.

2. Procedure

The procedure for obtaining a biopsy of the intestine by capsule and tube involves several detailed steps to ensure accurate tissue sampling. The following outlines the procedural steps:

Step 1: Preparation and Insertion The physician prepares the patient for the procedure, ensuring they understand the process. A capsule attached to a flexible tube is inserted into the patient's mouth, and the patient is instructed to swallow it. This initial step is crucial for the successful passage of the capsule and tube through the gastrointestinal tract.
Step 2: Passage to the Stomach Once the capsule and tube reach the stomach, the patient is instructed to drink water and change positions as directed. This helps facilitate the movement of the capsule and tube through the digestive system, allowing them to reach the jejunum.
Step 3: Advancement to the Jejunum The physician may alternatively pass a flexible tube through the mouth into the stomach, advancing it through the pylorus and into the duodenum. The tube is carefully manipulated to reach the duodenojejunal junction and into the first loop of the jejunum, where the first set of specimens is typically obtained.
Step 4: Biopsy Collection Once in the jejunum, the biopsy capsule is activated to collect tissue samples. The physician may take biopsies from this area, and if necessary, the tube can be advanced further to obtain additional specimens from the jejunum or duodenum.
Step 5: Withdrawal and Specimen Preparation After the biopsies are taken, the tube is completely withdrawn from the gastrointestinal tract. The collected specimens are then prepared and sent to the laboratory for evaluation, which is reported separately.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications or discomfort following the biopsy. Patients may be advised to rest and avoid strenuous activities for a short period. It is essential to provide instructions regarding any potential symptoms to watch for, such as abdominal pain, bleeding, or signs of infection. The physician will typically discuss the expected timeline for receiving biopsy results and any follow-up appointments that may be necessary to review the findings and determine further management based on the results of the biopsy.

Short Descr	BIOPSY OF BOWEL
Medium Descr	BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS
Long Descr	Biopsy of intestine by capsule, tube, peroral (1 or more specimens)
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator	Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P6C - Minor procedures - other (Medicare fee schedule)
MUE	1
CCS Clinical Classification	92 - Other bowel diagnostic procedures

Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).

Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.