Accurately Report Pouchoscopy and Overcome Keofeed Reporting Confusion

Know How to Appropriately Report Pouchoscopy With Additional Procedures

Question: Your gastroenterologist recently carried out a pouchoscopy. (The operative report read like this: The patient was turned around and the scope was changed to an Olympus P CF-180 pediatric video colonoscope. There was an anal stricture but I was able to get the scope beyond this. There was inflamed tissue at 40 cm. I bypassed this. There was a stricture at 100 cm and I was unable to bypass it with the scope. I dilated that with a 20 mm balloon. Then I was able to bypass the stricture and the ileum proximal to it appeared normal. The colonoscope was slowly withdrawn and the ileum and pouch were decompressed. The anus was dilated with a 50 French Maloney dilator. The procedure was then terminated. He tolerated it well. There were no immediate complications.)

Should you use a colonoscopy CPT® code to describe the procedure that was carried out?

Answer: Colonoscopy is a diagnostic procedure used to discover problems in the colon or the rectum. A pouchoscopy is carried out on the small intestinal (abdominal or pelvic) pouch. Thus, a colonoscopy CPT® code cannot be used in case pouchoscopy is the procedure your gastorenteroloist is carrying out. If pouchoscopy was the only procedure that your gastroenterologist carried out, then you have to report the procedure using medical billing code 44385 (Endoscopic evaluation of small intestinal [abdominal or pelvic] pouch; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). However, since your gastroenterologist also used dilators to overcome the strictures, if you simply report the procedure with medical billing code 44385, your reporting will only be half-correct.

CPT® does not cover a lot of endoscopy procedures with separate medical billing codes. One such code that is not covered includes pouchoscopy together with dilation to overcome strictures using a balloon, bougie or a guidewire. As, CPT® does not have a distinct code for pouchoscopy with dilation you will have to report the pouchoscopy with 44385 and the dilation with 44799 (Unlisted procedure, intestine).

As you are reporting an unlisted procedure code, you will be required to submit a copy of the operative report together with documentation defining what additional procedures have been carried out by your gastroenterologist. The documentation must also include the time that was taken by your gastroenterologist to carry out the procedure.

Address the Keofeed Reporting Confusion

Question: Your gastroenterologist recently carried out a Keofeed feeding tube placement at our facility. How do you report this?

Answer: The placement procedures for feeding tubes is essentially reported based on the type and method that was used. A Keofeed feeding tube is a kind of nasogastric tube. Nasogastric tubes, as the name specifies, are inserted via the nose into the stomach. The tube insertion is carried out largely for feeding purposes and also for the administration of drugs and other agents for instance activated charcoal. You must report the placement of a nasogastric tube with medical billing  Codes 43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]).