enteroscopy

DEFINITION of enteroscopy

Enteroscopy is a specialized gastrointestinal endoscopic procedure in which a long, flexible endoscope is passed transoral and antegrade (via the mouth, advancing forward) beyond the second portion of the duodenum to examine the jejunum and, when required, the ileum — segments of the small intestine that are anatomically inaccessible by standard esophagogastroduodenoscopy (EGD) (which reaches only to the proximal duodenum) or standard colonoscopy (which accesses only the terminal ileum retrogradely). The procedure may be diagnostic (inspection, specimen collection by brushing or washing, biopsy) or therapeutic (control of bleeding, removal of polyps or foreign bodies, stent placement, jejunostomy tube placement). A critical CPT coding principle is that enteroscopy is defined by the most distal segment of small intestine that is visualized — not by the technology used or the type of scope employed. Specifically: if the scope reaches at least 50 cm beyond the pylorus but only into the jejunum, codes from the 44360-44373 family apply (enteroscopy, not including ileum); if the scope reaches the ileum, codes from the 44376-44379 family apply (enteroscopy, including ileum). If the endoscope cannot be advanced at least 50 cm beyond the pylorus, the encounter must be downgraded to the appropriate EGD family code (43235-43270).

Clinical Indicators: Documentation must clearly state the most distal extent of intubation. Retrograde examination of the small intestine via anus or stoma does NOT use enteroscopy codes — those should be reported with 44799 (unlisted small intestine procedure).

ETYMOLOGY of enteroscopy

greek

Component Origin Meaning
enter(o)- Ancient Greek ἔντερον (énteron) “Intestine” — the root specifically denoting the bowel or intestinal tract; appears in gastroenterology, enteritis, dysentery
-scopy Ancient Greek σκοπέω (skopéō) “To look at, to examine, to behold” — denoting a process of visual examination; appears in endoscopy, colonoscopy, laparoscopy
-scope Ancient Greek σκόπος (skópos) “Watcher, observer” — denoting the instrument itself used for examination; appears in stethoscope, bronchoscope

Literally: “To look into the intestine” — a precise anatomical description of the procedure’s purpose. The parent term endoscopy itself derives from ἔνδον (éndon, “inside”) + σκοπέω (skopéō, “to look”), meaning “to look inside,” with the prefix entero- narrowing the site of examination to the intestinal tract. Endoscopic examination of the body interior traces its earliest conceptual roots to Hippocratic-era medicine of the fifth century BC, though the formalized instruments and terminology are products of nineteenth-century clinical innovation following the development of artificial illumination for medical use.

Component	Origin	Meaning
enter(o)-	Ancient Greek ἔντερον (énteron)	“Intestine” — the root specifically denoting the bowel or intestinal tract; appears in gastroenterology, enteritis, dysentery
-scopy	Ancient Greek σκοπέω (skopéō)	“To look at, to examine, to behold” — denoting a process of visual examination; appears in endoscopy, colonoscopy, laparoscopy
-scope	Ancient Greek σκόπος (skópos)	“Watcher, observer” — denoting the instrument itself used for examination; appears in stethoscope, bronchoscope

🔀 ALIASES / ALTERNATE TERMS

Term Context
Push enteroscopy The traditional technique in which a long enteroscope is manually pushed forward; the most common method and the one reflected in the 44360-44379 CPT code family.
Balloon-assisted enteroscopy (BAE) An advanced technique using single-balloon (SBE) or double-balloon (DBE) systems to pleat the small bowel over the scope, allowing deeper intubation; CPT coding is the same family — determined by depth, not technique.
Antegrade enteroscopy A directional descriptor clarifying the scope is advanced orally in the forward direction (as opposed to retrograde/anal approach).
Small bowel endoscopy A broad synonym used in CPT code descriptors; the formal language used in the 44360-44379 code series.
Deep enteroscopy A clinical term for balloon-assisted or spiral-assisted techniques that achieve visualization of the mid-to-distal ileum; not a separate CPT concept — still coded by depth of intubation.

Term	Context
Push enteroscopy	The traditional technique in which a long enteroscope is manually pushed forward; the most common method and the one reflected in the 44360-44379 CPT code family.
Balloon-assisted enteroscopy (BAE)	An advanced technique using single-balloon (SBE) or double-balloon (DBE) systems to pleat the small bowel over the scope, allowing deeper intubation; CPT coding is the same family — determined by depth, not technique.
Antegrade enteroscopy	A directional descriptor clarifying the scope is advanced orally in the forward direction (as opposed to retrograde/anal approach).
Small bowel endoscopy	A broad synonym used in CPT code descriptors; the formal language used in the 44360-44379 code series.
Deep enteroscopy	A clinical term for balloon-assisted or spiral-assisted techniques that achieve visualization of the mid-to-distal ileum; not a separate CPT concept — still coded by depth of intubation.

🔗 RELATED TERMS

Capsule endoscopy (small intestine) — 91110; a non-invasive, swallowed wireless camera that images the entire small bowel; frequently used as the diagnostic precursor to therapeutic enteroscopy when a small bowel lesion is suspected but not yet localized.

esophagogastroduodenoscopy (EGD) — 43235 (diagnostic); standard upper GI endoscopy reaching only to the proximal duodenum; if the scope cannot advance ≥50 cm beyond the pylorus, the encounter defaults to the EGD family rather than the enteroscopy family.

Obscure gastrointestinal bleeding (OGIB) — K92.1; the single most common clinical indication driving enteroscopy; refers to ongoing or recurrent GI hemorrhage for which a source is not identified on EGD or colonoscopy, necessitating small bowel examination.

Crohn’s disease of small intestine — K50.00 (without complications); a major inflammatory indication for enteroscopy, particularly for stricture dilation or biopsy of small bowel Crohn’s disease not accessible by colonoscopy alone.

Angiodysplasia — K31.811 (angiodysplasia of stomach and duodenum with hemorrhage); vascular malformations of the small bowel are among the most frequent findings and therapeutic targets during enteroscopy for OGIB.

Ileoscopy through stoma — 44380 (diagnostic); a related but distinct procedure code family for retrograde examination of the ileum via a stoma; not an enteroscopy code — separate CPT family entirely.

Pouchoscopy — 44385 (diagnostic); endoscopic evaluation of an ileal pouch (e.g., J-pouch, Kock pouch) after colectomy with ileo-anal anastomosis; also its own distinct CPT family.

CODING CORNER

🏥 ICD-10-CM CODES

Common Diagnoses Driving Enteroscopy

⚠️ ICD-10-CM / Chapter Nuances: Enteroscopy does not have its own ICD-10-CM procedure code in the CM system (ICD-10-CM is diagnosis, not procedure). Code the clinical indication that necessitated the enteroscopy. For inpatient facility coding, ICD-10-PCS procedure codes apply. The diagnoses below represent the most common medical necessity conditions documented for enteroscopy authorization and claim submission.

Code Description
K92.1 Melena (Lower obscure GI bleed presenting as dark/tarry stool; a frequent driver of enteroscopy when EGD and colonoscopy are non-diagnostic)
K92.2 Gastrointestinal hemorrhage, unspecified (Use when bleeding is documented but not further classified; ensure specificity is maximized when documentation supports a more specific code)
K31.811 Angiodysplasia of stomach and duodenum with hemorrhage (Vascular malformation with active bleeding; a primary target for argon plasma coagulation during therapeutic enteroscopy)
K31.819 Angiodysplasia of stomach and duodenum without hemorrhage
K50.00 Crohn’s disease of small intestine without complications (Code small bowel Crohn’s requiring enteroscopic evaluation or dilation of a stricture)
K50.012 Crohn’s disease of small intestine with rectal bleeding
K50.013 Crohn’s disease of small intestine with fistula
K50.014 Crohn’s disease of small intestine with abscess
K50.018 Crohn’s disease of small intestine with other complication
K50.019 Crohn’s disease of small intestine with unspecified complications
K57.10 Diverticulosis of small intestine without perforation or abscess, without bleeding
K57.11 Diverticulosis of small intestine without perforation or abscess, with bleeding
K57.12 Diverticulitis of small intestine without perforation or abscess, without bleeding
K57.13 Diverticulitis of small intestine without perforation or abscess, with bleeding
D13.39 Benign neoplasm of other parts of small intestine (Code for benign small bowel polyp or tumor identified and removed/biopsied during enteroscopy)
C17.1 Malignant neoplasm of jejunum (Primary small bowel malignancy; enteroscopy used for biopsy and staging evaluation)
C17.2 Malignant neoplasm of ileum
K63.81 Dieulafoy lesion of intestine (An arterial submucosal vascular malformation and notoriously difficult-to-locate cause of massive GI bleeding)
Z87.39 Personal history of other endocrine, nutritional and metabolic diseases (May apply for surveillance enteroscopy in patients with prior small bowel polyposis, e.g., Peutz-Jeghers syndrome)

🔧 COMMON CPT CODES

Enteroscopy, NOT Including Ileum (Jejunum Only — 44360-44373 Family)

⚠️ CPT Nuance: Use this family when the scope is advanced at least 50 cm beyond the pylorus but does NOT reach the ileum. The base/diagnostic code 44360 is the foundation; all therapeutic codes in this family are reported instead of (not in addition to) the diagnostic base. Do NOT report 44360 separately when a therapeutic code is performed.

CPT Code Description
44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (The base/anchor code for the jejunal-only enteroscopy family)
44361 …with biopsy, single or multiple (Report instead of 44360 when a biopsy is taken; the most common therapeutic upgrade in this family)
44363 …with removal of foreign body
44364 …with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
44365 …with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
44366 …with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) (Report for therapeutic hemostasis during enteroscopy; do NOT separately report submucosal injection if it was part of the bleeding control)
44369 …with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery, or snare technique (Includes pre- and post-dilation and guide wire passage when performed; do NOT add modifier -52 if not all components performed)
44370 …with transendoscopic stent placement (includes predilation)
44372 …with placement of percutaneous jejunostomy tube
44373 …with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube

Enteroscopy, INCLUDING Ileum (44376-44379 Family)

⚠️ CPT Nuance: Use this family when scope advancement is confirmed to have reached the ileum. This is a distinct, higher-complexity family from 44360-44373 and reflects the added technical difficulty of deep intubation. Documentation must explicitly state that the ileum was visualized.

CPT Code Description
44376 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (Base/anchor code for the ileum-inclusive enteroscopy family)
44377 …with biopsy, single or multiple
44378 …with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)
44379 …with transendoscopic stent placement (includes predilation)

Related Procedures — Capsule Endoscopy

CPT Code Description
91110 Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), small intestine, with interpretation and report (Non-invasive wireless capsule camera for diagnostic imaging of the entire small bowel; frequently ordered prior to enteroscopy to localize a lesion before therapeutic intervention)
91111 Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus, with interpretation and report (Esophageal capsule; do NOT report with 91110)

Modifiers Commonly Used

Modifier Usage
-53 Discontinued procedure — Append to 44360 or 44376 when the scope is advanced to an enteroscopy entry point but the procedure must be terminated prematurely due to extenuating clinical circumstances (anesthesia was administered); do NOT use -52 in this scenario for a diagnostic enteroscopy
-52 Reduced services — Append to a therapeutic enteroscopy code (e.g., 44366) when the physician elects to reduce the service prior to full completion and no anesthesia was involved, per AMA CPT guidelines
-59 Distinct procedural service — Use when dilation of multiple strictures is performed during enteroscopy at separate, distinct small bowel sites (report the dilation code with -59 for each additional stricture beyond the first)
-25 Significant, separately identifiable E/M service — Append to 99213 or 99214 if the gastroenterologist performs a significant, separately documented E/M on the same day as an enteroscopy procedure
-51 Multiple procedures — May apply when enteroscopy is performed on the same day as a separate, distinct endoscopic procedure at a different anatomical site (e.g., a same-day EGD and enteroscopy); verify payer policy, as many GI payers follow the multiple endoscopy payment rule instead

⚠️ Coding Note: The highest compliance risk in enteroscopy coding is selecting the wrong family (44360 vs. 44376) due to inadequate documentation of the depth of intubation. If the operative note states only “small bowel enteroscopy performed” without specifying whether the ileum was visualized, the coder must query the provider — coding to the ileum-inclusive family without documentation support is upcoding. A second major risk is reporting 44360 in addition to a therapeutic code in the same family; the diagnostic base code is always bundled into the therapeutic code and cannot be separately billed. Finally, be cautious with retrograde small bowel examination (e.g., examining the small intestine via anus after ileostomy takedown) — this does NOT use the 44360 or 44376 families; it must be reported with 44799 (unlisted small intestine procedure). For same-day capsule endoscopy and enteroscopy, verify payer-specific NCCI bundling rules, as 91110 and enteroscopy codes are typically payable separately when both services are medically necessary and distinctly documented.

Code	Description
K92.1	Melena (Lower obscure GI bleed presenting as dark/tarry stool; a frequent driver of enteroscopy when EGD and colonoscopy are non-diagnostic)
K92.2	Gastrointestinal hemorrhage, unspecified (Use when bleeding is documented but not further classified; ensure specificity is maximized when documentation supports a more specific code)
K31.811	Angiodysplasia of stomach and duodenum with hemorrhage (Vascular malformation with active bleeding; a primary target for argon plasma coagulation during therapeutic enteroscopy)
K31.819	Angiodysplasia of stomach and duodenum without hemorrhage
K50.00	Crohn’s disease of small intestine without complications (Code small bowel Crohn’s requiring enteroscopic evaluation or dilation of a stricture)
K50.012	Crohn’s disease of small intestine with rectal bleeding
K50.013	Crohn’s disease of small intestine with fistula
K50.014	Crohn’s disease of small intestine with abscess
K50.018	Crohn’s disease of small intestine with other complication
K50.019	Crohn’s disease of small intestine with unspecified complications
K57.10	Diverticulosis of small intestine without perforation or abscess, without bleeding
K57.11	Diverticulosis of small intestine without perforation or abscess, with bleeding
K57.12	Diverticulitis of small intestine without perforation or abscess, without bleeding
K57.13	Diverticulitis of small intestine without perforation or abscess, with bleeding
D13.39	Benign neoplasm of other parts of small intestine (Code for benign small bowel polyp or tumor identified and removed/biopsied during enteroscopy)
C17.1	Malignant neoplasm of jejunum (Primary small bowel malignancy; enteroscopy used for biopsy and staging evaluation)
C17.2	Malignant neoplasm of ileum
K63.81	Dieulafoy lesion of intestine (An arterial submucosal vascular malformation and notoriously difficult-to-locate cause of massive GI bleeding)
Z87.39	Personal history of other endocrine, nutritional and metabolic diseases (May apply for surveillance enteroscopy in patients with prior small bowel polyposis, e.g., Peutz-Jeghers syndrome)

CPT Code	Description
44360	Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (The base/anchor code for the jejunal-only enteroscopy family)
44361	…with biopsy, single or multiple (Report instead of 44360 when a biopsy is taken; the most common therapeutic upgrade in this family)
44363	…with removal of foreign body
44364	…with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
44365	…with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
44366	…with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) (Report for therapeutic hemostasis during enteroscopy; do NOT* separately report submucosal injection if it was part of the bleeding control)*
44369	…with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery, or snare technique (Includes pre- and post-dilation and guide wire passage when performed; do NOT add modifier -52 if not all components performed)
44370	…with transendoscopic stent placement (includes predilation)
44372	…with placement of percutaneous jejunostomy tube
44373	…with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube

CPT Code	Description
44376	Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (Base/anchor code for the ileum-inclusive enteroscopy family)
44377	…with biopsy, single or multiple
44378	…with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)
44379	…with transendoscopic stent placement (includes predilation)

CPT Code	Description
91110	Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), small intestine, with interpretation and report (Non-invasive wireless capsule camera for diagnostic imaging of the entire small bowel; frequently ordered prior to enteroscopy to localize a lesion before therapeutic intervention)
91111	Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus, with interpretation and report (Esophageal capsule; do NOT report with 91110)

Modifier	Usage
-53	Discontinued procedure — Append to 44360 or 44376 when the scope is advanced to an enteroscopy entry point but the procedure must be terminated prematurely due to extenuating clinical circumstances (anesthesia was administered); do NOT use -52 in this scenario for a diagnostic enteroscopy
-52	Reduced services — Append to a therapeutic enteroscopy code (e.g., 44366) when the physician elects to reduce the service prior to full completion and no anesthesia was involved, per AMA CPT guidelines
-59	Distinct procedural service — Use when dilation of multiple strictures is performed during enteroscopy at separate, distinct small bowel sites (report the dilation code with -59 for each additional stricture beyond the first)
-25	Significant, separately identifiable E/M service — Append to 99213 or 99214 if the gastroenterologist performs a significant, separately documented E/M on the same day as an enteroscopy procedure
-51	Multiple procedures — May apply when enteroscopy is performed on the same day as a separate, distinct endoscopic procedure at a different anatomical site (e.g., a same-day EGD and enteroscopy); verify payer policy, as many GI payers follow the multiple endoscopy payment rule instead

DERIVATIONS of enteroscopy

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Query functionality

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Med roots Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms

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enteroscopy

🏥 ICD-10-CM CODES

Common Diagnoses Driving Enteroscopy

🔧 COMMON CPT CODES

Enteroscopy, NOT Including Ileum (Jejunum Only — 44360-44373 Family)

Enteroscopy, INCLUDING Ileum (44376-44379 Family)

Modifiers Commonly Used

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Prefixes and Suffixes