Coding guide for Gastrostomy Tube Placements CPT codes

A percutaneous insertion of a gastrostomy tube is performed under fluoroscopic guidance. Gastrointestinal tube procedures involve percutaneous placement of a tube through the skin, directly into the stomach, small bowel, or large bowel, to allow feedings and/or suction of gastrointestinal contents.

We have learnt previously similar exam like chest tube placement, abscess removal cpt codes, incision and drainage cpt code etc.

Clinical indication for gastrostomy tube placement includes the esophageal or gastric obstruction, gastroesophageal reflux requiring tube feedings, gastroparesis, colonic obstruction, spina bifida, spinal cord injury, fecal incontinence etc.

A gastrojejunostomy is a tube placed through the stomach wall, which extends across the pylorus and duodenum into the jejunum. There is usually a suction portion of the tube in the stomach while the feeding portion of the tube is in the jejunum.

A gastrostomy is a tube placed through the stomach wall, while a jejunostomy is a tube placed through the jejunal wall.

Code description of Gastrostomy tube placement CPT codes

The physician inserts a gastrostomy tube via percutaneous (under the skin) approach using fluoroscopic guidance. Percutaneous image-guided gastrostomy or enterostomy procedures may be indicated for patients who have an impaired swallowing mechanism, mechanical obstruction of the upper GI tract due to malignancy, or those with aberrant upper GI anatomy. Following administration of any necessary sedation, nasogastric or orogastric intubation is performed under fluoroscopic guidance and the stomach is insufflated. The skin and subcutaneous tissues overlying the stomach are anesthetized with lidocaine. Using a subcostal (below the ribs) approach and fluoroscopic guidance, the physician inserts a 7 cm, 18-gauge needle in the area of the horizontal portion of the greater curvature. A guidewire is then passed through the needle and the needle is withdrawn. A dilator is introduced over the wire and the tract is dilated. The physician places a self-retaining loop catheter into the stomach and injects a small amount of contrast material in order to confirm placement. A loop-locking suture is tied and nasogastric or orogastric tubes are removed. Antiseptic ointment and sterile dressings are applied. CPT code 49440 code includes image documentation and report.

49440 – Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

Following administration of any necessary sedation and contrast materials, the physician identifies a suitable site for puncture of the duodenum or jejunum and a needle is inserted percutaneously. When the contrast material can be aspirated from the needle, a guidewire is inserted under fluoroscopic guidance. The tract is dilated and an appropriate catheter is inserted and secured to the skin with a stoma device. Nasogastric or orogastric tubes are removed. Antiseptic ointment and sterile dressings are applied. CPT code 49441 code includes image documentation and report.

49441 – Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

A cecostomy is placed percutaneously through the colonic wall to drain the cecum or any other obstructed portion of the colon.

49442 – Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

Percutaneous insertion of a cecostomy or other colonic tube is performed under fluoroscopic guidance. The cecostomy tube is usually performed for fecal incontinence.

49446 – Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

Do remember, if an existing gastrostomy, duodenostomy, 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.

Do and Don’t with Gastrostomy CPT codes

All Gastrointestinal tube placement codes includes fluoroscopy, contrast injection, images and placement of tube.

Do use CPT code 49441 and 49440 if a percutaneous transgastric jejunostomy and a separate decompressive gastrostomy via two access sites are performed.
Do use CPT code 49442 for percutaneous cecostomy or other percutaneous colonic tube placement.
Do use both CPT codes 49440 and 49446 to describe the initial placement of a gastrojejunostomy tube via a single access site.
Use only code 49446 (and not 49440 or 49450) for conversion of an existing gastrostomy tube to a new gastrojejunostomy tube. Conversion consists of removal of the old gastrostomy tube followed by placement of a gastrojejunostomy tube over the same wire.

References:

https://www.outsourcestrategies.com/resources/gastrostomy-tube-placement

https://www.dovemed.com/common-procedures/

https://www.icd10monitor.com/icd-10-coding-the