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A colonoscopy is a medical procedure that involves the examination of the interior lining of the colon (large intestine) and rectum. In the case of CPT® Code 44392, this procedure is specifically performed through an existing stoma, which is an opening created surgically on the abdomen to allow for the passage of stool. During this colonoscopy, the endoscope, a flexible tube equipped with a camera and light, is introduced through the colostomy opening. The physician inspects the mucosal surfaces of the colon, extending from the stoma to the cecum or a small intestine anastomosis, to identify any abnormalities such as tumors, polyps, or lesions. Once any abnormal growths are identified, the procedure involves the use of hot biopsy forceps to remove these lesions. The hot biopsy technique is notable for its dual function: it not only excises the tissue but also cauterizes it simultaneously, minimizing bleeding and promoting healing. This method is particularly effective for small polyps and vascular ectasias, which are abnormal blood vessel formations. The distinction between this procedure and others, such as CPT® Code 44394, lies in the tools and techniques used for lesion removal. In contrast to the hot biopsy forceps, the latter utilizes a wire snare loop to excise lesions, which can be done in a single motion or in multiple steps. Overall, CPT® Code 44392 encapsulates a critical intervention for managing colorectal abnormalities in patients with a stoma.
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The procedure associated with CPT® Code 44392 is indicated for the following conditions:
The procedure begins with the patient being positioned appropriately to facilitate access to the stoma. The physician then prepares the area and ensures that the necessary equipment, including the endoscope and hot biopsy forceps, is ready for use. The endoscope is gently inserted through the colostomy opening, allowing the physician to visualize the mucosal surfaces of the colon. As the endoscope is advanced, the physician inspects the colon from the stoma to the cecum or small intestine anastomosis, carefully noting any abnormalities such as tumors, polyps, or lesions. Once identified, the physician utilizes hot biopsy forceps to remove the lesions. The hot biopsy forceps are designed to excise tissue while simultaneously applying heat to cauterize the area, which helps to minimize bleeding. This technique is particularly effective for small polyps and vascular ectasias. The physician may need to manipulate the endoscope to ensure complete visualization and access to the lesions. After the lesions are removed, the endoscope is withdrawn, and the physician may perform a final inspection of the colon to ensure that all areas have been adequately examined and any abnormalities addressed.
After the completion of the colonoscopy through the stoma, patients are typically monitored for any immediate complications, such as bleeding or perforation. Post-procedure care may include instructions on dietary modifications and activity restrictions to promote healing. Patients may experience some discomfort or cramping, which is generally expected and can be managed with over-the-counter pain relief. Follow-up appointments may be scheduled to discuss pathology results from any biopsies taken during the procedure and to plan further management if necessary. It is essential for patients to report any unusual symptoms, such as excessive bleeding or signs of infection, to their healthcare provider promptly.
| Short Descr | COLONOSCOPY & POLYPECTOMY | Medium Descr | COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS | Long Descr | Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps | 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) | 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. | Endoscopic Base Code | 44388 Colonoscopy through stoma; 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 | 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) | P8D - Endoscopy - colonoscopy | MUE | 1 | CCS Clinical Classification | 76 - Colonoscopy and biopsy |
| PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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). | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AG | Primary physician | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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. |
| 2015-01-01 | Changed | Description Changed |
| Pre-1990 | Added | Code added. |
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