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).
“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.
🔀 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 44360-44379CPT 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).
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.
Gastrointestinal hemorrhage, unspecified (Use when bleeding is documented but not further classified; ensure specificity is maximized when documentation supports a more specific code)
Angiodysplasia of stomach and duodenum with hemorrhage (Vascular malformation with active bleeding; a primary target for argon plasma coagulation during therapeutic enteroscopy)
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.
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)
…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)
…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)
…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.
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)
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)
Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus, with interpretation and report (Esophageal capsule; do NOT report with 91110)
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
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
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)
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
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.