Cracking the Code
Coding Scopes Through Stomas
Documentation in the operative report of a puncture made into the abdomen and the end of the bowel that was brought out indicates the creation of a stoma (colostomy). Endoscopic procedures are split into two subheadings in the intestine section. The first is for Endoscopy, Small Intestine (44360–44379), beyond the second portion of the duodenum, and the second is Endoscopy Stomal (44380–44384), where the scope is inserted via an existing ileostomy. Colonoscopies performed via the stoma can be found in this section and with codes 44388–44408.
According to CPT Assistant “Colonoscopy through stoma, defined as the examination of the colon, from the colostomy stoma to the cecum or colon–small intestine anastomosis, may include examination of the terminal ileum or small intestine immediately proximal to an anastomosis. Endoscopy, Small Intestine, and Stomal subsection of the Surgery section in the CPT code set was divided into two separate sections: one for small intestine endoscopy (44360-44379) and one for stomal endoscopy (44380-44408).
Most of the editorial revisions to this code section were made to clarify the method for performing the procedure, as well as to update the terminology from “with or without” to “including” and add “when performed” where necessary. For example, CPT code 44380, Ileoscopy, through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed [separate procedure]).” Here the provider examines the ileum using an endoscope, a tubular instrument with a light source and camera, which he inserts through a previously placed stoma, the opening on the skin of a surgically created passageway into the ileum to check for the presence of a bowel disease. He takes samples of any suspicious tissue by brushing or washing the area to collect cells for laboratory analysis. Another example would be CPT code 44382, Ileoscopy, through stoma, with biopsy, single or multiple. During this procedure, the provider examines the ileum using an endoscope passed through a previously placed stoma, an opening, on the skin of a surgically created passageway into the ileum. If he sees any areas of abnormal mucosa or tissue, he biopsies one or more suspicious areas and sends it to the laboratory for histopathologic examination.