subject: Gastroenterology Coding Update: Ensure Tube Changes Claim Success [print this page] When your gastroenterologist deals with any of the various types of gastrointestinal (GI) tubes, you should examine how he carried out the proceudre to the patient to determine the right CPT codes.
Gastrointestinal procedures contain three main types which are initial tube placement, tube placement, and tube maintenance. Each provides a unique set of guidance that calls for a different coding approach. Follow it to a T, and you will always be safe. Heres what our experts have to say.
If your gastroenterologist carried out an initial, percutaneous insertion of a gastrostomy tube, without using an endoscope and including radiologic supervision and interpretation, report 49440.
In this procedure, the gastroenterologist creates a puncture through the patients abdominal wall from outside the body, and inserts a device under fluoroscopic or ultrasound guidance. This allows the doctor to pull the stomach up to the abdominal wall and then insert the tube percutaneously without using an endoscope.
Flashback: Earlier, you would report this procedure using 43750. However in 2008, CPT deleted this code. Its replacement 49440 covers all of the components to place the tube, including the associated imaging procedures.
Watch your maintenance procedures
For maintenance services, you should familiarize yourself with another set of codes which includes 49460 and 49465.
Remember that codes 49440-49442, 49450-49452, 49460, and 49465 all include fluoroscopic guidance.
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