Summary & Overview
CPT 44391: Colonoscopy via Colostomy Stoma with Endoscopic Repair
CPT code 44391 denotes a colonoscopic examination and endoscopic repair of bleeding in the remaining colon accessed through a previously created colostomy stoma. This code captures evaluation and therapeutic intervention performed via a colonoscope inserted through the stoma rather than the anus. It matters nationally because patients with colostomies require specialized access and billing clarity for diagnostic and therapeutic endoscopy when managing post-surgical bleeding or mucosal disease.
Key payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 44391 is used, typical sites of service, and the clinical rationale for endoscopic repair through a stoma. The publication summarizes benchmarks and coding considerations, highlights payer coverage patterns where available, and outlines how this service fits into endoscopy and colorectal care workflows.
The report is intended for clinicians, coding professionals, and policy analysts seeking a clear description of the service represented by CPT code 44391, guidance on contexts in which the code applies, and the kinds of metrics and policy updates that affect coding and coverage decisions. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 44391 describes an endoscopic evaluation of the remaining colon through an existing colostomy stoma using a colonoscope. The procedure involves insertion of the colonoscope through a previously created colostomy opening on the abdominal skin, visualization of the colonic mucosa, identification of bleeding sources within the remnant colon, and endoscopic repair of those bleeding areas.
Service type: Endoscopic therapeutic diagnostic procedure (colonoscopy via colostomy stoma)
Typical site of service: Ambulatory surgical center or hospital outpatient department, where colonoscopic equipment and endoscopic therapeutic capability are available.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a prior left hemicolectomy and a permanent end colostomy presents for surveillance and evaluation of intermittent bright red bleeding from the stoma and new onset cramping. The colorectal surgeon schedules a stoma colonoscopy to inspect the remaining colon through the previously created colostomy stoma. On arrival to the outpatient endoscopy suite, the patient undergoes pre-procedure assessment, informed consent specific to 44391, and standard sedation screening. The procedure is performed with conscious sedation by the attending colorectal surgeon and an assisting registered nurse. A colonoscope is introduced through the colostomy stoma; the mucosa of the remaining colon is carefully inspected. A localized oozing vascular lesion is identified in the sigmoid remnant and treated endoscopically with bipolar cautery for hemostasis. Post-procedure recovery includes monitoring in the PACU, discharge instructions for stoma care, and scheduling of pathology follow-up or repeat surveillance as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician professional component separate from facility/technical charges. |
50 |