Summary & Overview
CPT 44379: Upper Endoscopy with Dilation and Stent Placement
CPT code 44379 represents a combined diagnostic and therapeutic upper gastrointestinal endoscopy in which the clinician examines the upper digestive tract from the esophagus to the ileum and, upon finding a stricture, performs dilation and places an endoscopic stent to maintain patency. This procedure is clinically important because it prevents or relieves obstruction, preserves oral intake, and can be performed in acute and chronic obstructive conditions across a broad patient population. Nationally, proper coding and coverage of this service affect access to minimally invasive palliation and definitive care for obstructive gastrointestinal disease.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks for coding and utilization trends, an outline of common payer coverage considerations, and clinical context about when combined dilation and stent placement is typically performed. The publication summarizes reimbursement and billing nuances relevant to hospital outpatient departments and ambulatory surgery centers, highlights documentation elements that support use of CPT code 44379, and flags policy updates or payment topics that influence authorization and claim adjudication. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 44379 describes a diagnostic and therapeutic upper gastrointestinal endoscopic procedure using a lighted endoscope. The provider performs a visual examination of the upper digestive tract from the esophagus through the ileum. When a narrowing or stricture is identified, the clinician dilates the narrowed segment and deploys an endoscopic stent through the scope to maintain luminal patency and reduce the risk of obstruction.
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Service type: Combined diagnostic upper endoscopy with therapeutic stent placement
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Typical site of service: Hospital outpatient department or ambulatory surgery center where endoscopic procedures are performed
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive dysphagia and weight loss is evaluated for suspected malignant gastric outlet obstruction. The patient undergoes a planned therapeutic upper endoscopy under monitored anesthesia care. The endoscopist performs a diagnostic visual inspection of the esophagus, stomach, and proximal small bowel with a lighted endoscope, identifies a malignant-appearing stricture in the distal stomach/duodenal bulb, performs endoscopic dilation of the stricture, and deploys a self-expanding metal stent across the narrowed segment to restore luminal patency and allow oral intake. The procedure is typically performed in an endoscopy suite or ambulatory surgery center; anesthesia may be conscious sedation or general anesthesia depending on patient comorbidity and institutional practice. The care team includes the endoscopist (gastroenterologist or surgical endoscopist), endoscopy nurses, an anesthesia provider when indicated, and post-procedure recovery staff. Post-procedure documentation includes indication, description of endoscopic findings, dilation performed, stent type and size, fluoroscopic guidance if used, complications, estimated blood loss (usually minimal), and post-procedure instructions for diet advancement and follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician’s interpretation or professional work separate from technical facility services |