Summary & Overview
CPT 44364: Small-Bowel Endoscopy with Snare Lesion Removal
CPT code 44364 denotes an endoscopic examination of the small intestine that extends beyond the second portion of the duodenum but does not reach the ileum, combined with removal of one or more lesions using a snare device. This procedure is clinically important for diagnosis and removal of polyps, tumors, and other mucosal lesions in the proximal small bowel and can prevent progression to malignancy or relieve obstructive symptoms. Nationally, payers and facilities monitor utilization of advanced endoscopic procedures both for quality and cost containment.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical context, coding nuances, and payer coverage considerations relevant to this endoscopic therapeutic service.
Readers will learn: the clinical intent and typical settings for CPT code 44364; common billing and documentation elements tied to lesion removal with a snare; expected sites of service; and what information is available for benchmarking and policy review. Data not available in the input is explicitly noted where applicable. The focus is national in scope, intended for clinicians, billing staff, and policy analysts seeking a clear summary of the code’s purpose and operational context.
Billing Code Overview
CPT code 44364 describes an endoscopic examination of the small intestine that advances beyond the second portion of the duodenum but does not include the ileum. During the procedure the provider removes one or more tumors, polyps, or other lesions using a snare device.
-
Service type: Endoscopic diagnostic and therapeutic small bowel procedure with lesion removal (snare polypectomy)
-
Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in an endoscopy suite depending on facility capabilities and patient complexity.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with intermittent melena and iron-deficiency anemia is referred for an upper small-bowel endoscopic evaluation after prior negative esophagogastroduodenoscopy for gastric and duodenal sources. The gastroenterologist performs an upper endoscopy with an enteroscope advancing past the second portion of the duodenum into the jejunum (but not to the ileum) to inspect for bleeding sources and mucosal lesions. During the procedure, one or more polyps or small neoplastic-appearing lesions are identified and removed using a snare device with electrocautery. Tissue specimens are submitted for pathology. The typical workflow includes preprocedure consent, moderate sedation or monitored anesthesia care, endoscopic inspection, lesion removal by snare polypectomy, hemostasis as needed, specimen handling, and postprocedure recovery and discharge from an ambulatory endoscopy suite or hospital endoscopy unit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, difficulty, or intensity significantly exceeds typical expectations for 44364 (documentation must justify). |
52 |