The procedure involves destroying unhealthy bacteria in a patient's gut and then replacing the existing gut bacteria with new healthy gut bacteria isolated from another person (donor). This new procedure is now frequently being used to combat virulent strains of Clostridium difficile infections not responding to antibiotics or other forms of treatment. Fecal Microbiota can be transplanted by several routes like via colonoscopy, EGD, NG feeding tube or via rectal enema. Under anesthesia, the physician inserts a scope into the mouth (or other routes, as preferred) which is passed (or is attempted to pass) through the pylorus (pyloric sphincter) into the duodenum and/or jejunum. It helps gut microorganisms to repair or replace the disrupted native microbiota. This procedure also includes the assessment of donor specimen where the donor is tested for bacterial and parasitic infections. The fecal transplant material is then prepared and administered in a clinical environment to ensure that precautions are taken. It is given in constipation, irritable bowel syndrome and inflammatory bowel disease.
If your gastroenterologist performs a stool transplant, you will report part of this service with 44705 (Preparation of fecal microbiota for instillation, including assessment of donor specimen).
In addition to the preparation of the donor specimen (reported using 44705), you will have to use the appropriate code for the instillation of the specimen in the gut. Depending on choice, your gastroenterologist might perform a colonoscopy, EGD, rectal enema or a nasogastric tube to instill the specimen. For example, if your gastroenterologist uses an EGD to instill the specimen, you should report 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) along with 44705 for the preparation of the specimen.
Example: Your gastroenterologist decides to perform stool transplant on a patient suffering from C. difficile infection not responding to antibiotic treatment and other forms of treatment. He decides to use a sample from the patient's spouse for the transplant. He orders a thorough assessment of the stool sample to check for communicable diseases and other parasitic infections. He then prepares a sample for instilling in the patient's gut.
Your gastroenterologist then performs a colonoscopy to instill the stool sample. You will report the services using 44705 for the preparation and assessment of the stool sample and 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) for the colonoscopy he performed to place the stool sample in the patient's gut.