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The CPT® Code 44364 refers to a specific medical procedure known as small intestinal endoscopy, particularly focusing on enteroscopy that extends beyond the second portion of the duodenum, excluding the ileum. This procedure involves the endoscopic examination of the small intestine, where the physician inspects the mucosal surfaces for any abnormalities. During this examination, the physician may encounter tumors, polyps, or other lesions that require removal. The removal is accomplished using a snare technique, which involves placing a wire snare loop around the lesion and applying heat to shave off and cauterize it. This technique allows for the complete excision of the lesion, either in one piece or in a piecemeal manner, depending on the size and nature of the lesion. The procedure is performed with the patient under local anesthesia, where the mouth and throat are numbed to facilitate the insertion of a flexible fiberoptic endoscope. The endoscope is advanced through the gastrointestinal tract, allowing for direct visualization of the duodenum and potentially the jejunum, while ensuring that the ileum is not included in this specific procedure. The use of this code indicates a comprehensive approach to diagnosing and treating conditions affecting the small intestine, particularly through minimally invasive techniques.
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The procedure associated with CPT® Code 44364 is indicated for the following conditions:
The procedure begins with the administration of local anesthesia to numb the mouth and throat, facilitating the insertion of the endoscope. A hollow mouthpiece is placed in the patient's mouth to keep it open during the procedure. The physician then inserts a flexible fiberoptic endoscope, which is advanced as the patient swallows. Once the endoscope passes beyond the cricopharyngeal region, it is carefully guided into the duodenum using direct visualization. The mucosal surfaces of the duodenum are inspected thoroughly, extending beyond the second portion, and any abnormalities such as tumors, polyps, or lesions are noted. The examination may also include the entire jejunum, but it is important to note that the ileum is not part of this procedure. After the initial inspection, the endoscope is withdrawn, allowing for a second inspection of the entire circumference of the duodenum and jejunum. If lesions are identified, a wire snare loop is placed around the lesion for removal. The snare is heated to effectively shave off and cauterize the lesion. Depending on the size and nature of the lesion, it may be removed in one complete piece or in a piecemeal fashion, requiring multiple applications of the snare. This technique is crucial for ensuring complete excision of the lesion while minimizing damage to surrounding tissues.
After the procedure, patients are typically monitored for any immediate complications related to the endoscopy or the removal of lesions. Recovery may involve observation for signs of bleeding or perforation, which are potential risks associated with the procedure. Patients may experience some discomfort or throat irritation due to the anesthesia and the insertion of the endoscope. It is essential for patients to follow any post-procedure instructions provided by their healthcare provider, which may include dietary modifications or restrictions on physical activity for a short period. Follow-up appointments may be scheduled to assess recovery and discuss any further treatment options if necessary.
| Short Descr | SMALL BOWEL ENDOSCOPY | Medium Descr | ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE | Long Descr | Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic 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) | 0 - 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. | Endoscopic Base Code | 44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | 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) | P8I - Endoscopy - other | MUE | 1 | CCS Clinical Classification | 99 - Other OR gastrointestinal therapeutic procedures |
| 51 | 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). | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| Pre-1990 | Added | Code added. |
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