What is the correct code for insertion of a percutaneous jejunostomy tube? What is the correct code for replacement (tube change) of a percutaneous jejunostomy tube? What is the correct code for insertion of a percutaneous gastrostomy tube with conversion to a jejunostomy tube at the same session? What is the correct code if an existing gastrostomy tube is converted to a jejunostomy tube at a separate setting?
Answer:
CPT 2008 includes new codes for image-guided percutaneous tube placement, conversion and replace
ment. These codes all require image guidance as a necessary component of the procedure. Code 49441, Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report, should be reported for image-guided
percutaneous jejunostomy tube insertion. For image-guided replacement (tube change), code 49451,
Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report, should be reported.
If an existing gastrostomy, duodenostomy, or jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube is removed and a new tube is placed via a separate percutaneous access site, the placement of the new tube is not considered a replacement and would be reported using the
appropriate initial placement codes 49440-49442.
If a gastrostomy tube is placed using image guidance and subsequently converted to a jejunostomy tube at
the same setting, both codes 49440 and 49446 are reported. If an existing gastrostomy tube is converted to a jejunostomy tube at a setting separate from the initial gastrostomy tube placement, then only 49446 is reported for the conversion because 49440 would have been reported for the initial placement of the gastrostomy tube performed at a prior setting.
Answer:
CPT 2008 includes new codes for image-guided percutaneous tube placement, conversion and replace
ment. These codes all require image guidance as a necessary component of the procedure. Code 49441, Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report, should be reported for image-guided
percutaneous jejunostomy tube insertion. For image-guided replacement (tube change), code 49451,
Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report, should be reported.
If an existing gastrostomy, duodenostomy, or jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube is removed and a new tube is placed via a separate percutaneous access site, the placement of the new tube is not considered a replacement and would be reported using the
appropriate initial placement codes 49440-49442.
If a gastrostomy tube is placed using image guidance and subsequently converted to a jejunostomy tube at
the same setting, both codes 49440 and 49446 are reported. If an existing gastrostomy tube is converted to a jejunostomy tube at a setting separate from the initial gastrostomy tube placement, then only 49446 is reported for the conversion because 49440 would have been reported for the initial placement of the gastrostomy tube performed at a prior setting.
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ReplyDeleteWhat if you are replacing a jejunostomy tube without fluoro? I have read to use 49451 with a modifier 52. Another option would be unlisted and compare it to 43760? Any thoughts would be appreciated.
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