Summary & Overview
CPT 44369: Endoscopic Laser/Radiofrequency Ablation of Upper Small Bowel Lesions
CPT code 44369 represents an endoscopic therapeutic procedure in which the provider examines the upper small intestine (excluding the ileum) and destroys tumors, polyps, or other lesions using laser or radiofrequency energy. This code captures a targeted, energy-based ablation approach distinct from other forms of lesion destruction and is relevant for practices offering advanced endoscopic therapies. Nationally, this code matters for facility and professional billing, appropriate coding of endoscopic ablation services, and payer coverage decisions for minimally invasive treatment of benign, precancerous, or obstructing small-bowel lesions.
Key payers in standard coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks on expected use and site-of-service patterns, clinical context about the procedure and indications, and notes on coding specificity that affect claim adjudication and billing practice. The publication outlines where the procedure is typically performed (hospital outpatient departments and ambulatory surgical centers), clarifies the service type as an endoscopic therapeutic ablation, and identifies common operational considerations relevant to billing and documentation. Data not available in the input for payer-specific reimbursement rates, associated taxonomies, and ICD-10 diagnoses are noted as such.
Billing Code Overview
CPT code 44369 describes endoscopic examination and destruction of lesions in the upper small intestine (excluding the ileum). The procedure involves visualization of the entire proximal small bowel and ablation of tumors, polyps, or other lesions using laser or radiofrequency energy rather than other ablation methods.
Service Type
- Endoscopic therapeutic procedure involving examination and energy-based destruction of lesions in the small intestine (excluding the ileum).
Typical Site of Service
- Hospital outpatient department or ambulatory surgical center, performed in an endoscopy suite under appropriate sedation or anesthesia, with access to endoscopic laser or radiofrequency equipment.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old presenting with intermittent crampy abdominal pain, iron-deficiency anemia, or partial small-bowel obstruction symptoms. Initial evaluation includes history, physical exam, laboratory testing, and cross-sectional imaging (CT enterography) suggesting a localized lesion in the proximal small intestine or duodenum. The gastroenterologist or colorectal surgeon schedules an intraoperative or endoscopic procedure to directly inspect the upper digestive tract up to the distal jejunum (excluding the ileum) and to ablate identified benign-appearing tumors, polyps, or obstructing lesions using laser or radiofrequency energy.
The clinical workflow includes preoperative consent and assessment, anesthesia evaluation (general anesthesia or monitored anesthesia care), endoscopic or laparoscopic access to the upper small bowel, lesion identification and characterization, application of laser or radiofrequency ablation to destroy the lesion(s), hemostasis, and post-procedure recovery with observation for bleeding, perforation, or pain. Specimens are typically not resected for formal pathology when ablation is used; if tissue diagnosis is required, biopsy or excisional sampling may be performed before or after ablation. Typical sites of service are the hospital operating room or ambulatory surgical center depending on patient comorbidity and expected complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default (no modifier) |