CPT® Code 44385

Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir [S or J]); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

The CPT® Code 44385 refers to the endoscopic evaluation of a small intestinal pouch, which may include structures such as a Kock pouch or an ileal reservoir configured in an S or J shape. A Kock pouch is a specialized type of continent ileostomy created from the terminal ileum following a colectomy. This pouch functions as a reservoir that allows bowel contents to be stored within the body until the patient opts to empty it using a hollow tube or catheter that is inserted through a nipple-type valve located on the skin. In contrast, S and J pouches are types of ileoanal reservoirs constructed from the small intestine after a total colectomy. These pouches are designed to connect to the anal canal and are named based on the configuration of the intestinal loops used in their creation. Typically, the formation of S and J pouches is executed in a two-stage surgical process, where a loop ileostomy is initially created and brought to the skin surface for a period of time, allowing the internal pouch to heal adequately before re-establishing continuity of the bowel. The endoscopic evaluation performed under CPT® Code 44385 is crucial for monitoring the health and condition of the small intestinal pouch. During this procedure, an endoscope is introduced into the pouch through the stoma or valve, enabling a thorough inspection of the mucosal lining. Additionally, this code encompasses the collection of cell samples through techniques such as brushing or washing saline fluid into the pouch, which are then retrieved for laboratory analysis. This diagnostic procedure is classified as a separate procedure, emphasizing its distinct role in the overall management of patients with these types of intestinal pouches.