Summary & Overview
CPT 44376: Diagnostic Upper GI Endoscopy with Brushing or Lavage
CPT code 44376 represents a diagnostic upper gastrointestinal endoscopy performed with a lighted endoscope that examines the upper digestive tract from the esophagus to the ileum and includes specimen collection by brushing or lavage for histopathologic analysis. This procedure is a key diagnostic tool for evaluating mucosal abnormalities, infections, and neoplastic processes in the upper GI tract, and it has national relevance for gastroenterology practice patterns, pathology workflows, and procedural utilization.
Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent and typical settings for the service, an outline of common modifiers associated with claims for this procedure, and the billing context needed for payer negotiations and coding integrity. The publication also covers benchmarks and reimbursement context where available, policy updates relevant to endoscopic specimen handling and coding, and clinical considerations that affect coding selection.
This summary equips coding professionals, revenue cycle staff, and clinical leaders with a clear description of CPT code 44376, the typical care setting, and the payer landscape to inform billing workflows and payer discussions at a national level.
Billing Code Overview
CPT code 44376 describes a diagnostic upper endoscopic procedure using a lighted endoscope to visually examine the upper gastrointestinal tract from the esophagus through the ileum. During the procedure the provider inspects mucosal surfaces and, when suspicious areas are encountered, collects specimens by passing a brushlike device through the endoscope to brush the mucosa or by instilling warm water and suctioning specimens through the endoscope for submission to pathology.
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Service type: Diagnostic upper gastrointestinal endoscopy with brushing and/or lavage for specimen collection
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Typical site of service: Endoscopy suite or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents to the gastroenterology clinic with progressive dysphagia, intermittent upper abdominal pain, and unexplained weight loss. The gastroenterologist schedules an upper endoscopic evaluation with mucosal brushing and washings for cytology to evaluate for suspected esophageal or gastric malignancy and to sample suspicious mucosal lesions. The patient arrives at an ambulatory endoscopy suite where nursing performs pre-procedure assessment and obtains informed consent. Conscious sedation is administered by the procedural team (or monitored anesthesia care if indicated). The provider advances a diagnostic upper endoscope from the oropharynx through the esophagus, stomach, and duodenum to the ileum as clinically indicated, performs a systematic visual inspection, documents mucosal findings, and, when abnormal mucosa is seen, collects cytologic specimens by passing a brush through the endoscope and/or performs a lavage with instillation and suctioning of warmed saline. Specimens are placed in appropriate media and sent to pathology for cytologic and histopathologic analysis. Post-procedure recovery is monitored in the endoscopy recovery area and discharge instructions are provided. Typical site of service is an outpatient ambulatory surgery center or hospital endoscopy suite. Service type: diagnostic endoscopic upper gastrointestinal evaluation with brushing/washings for cytology/histopathology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or default professional service |