# Replacing Jejunostomy tube



## jvargocpc

I have a patient who came in to our ER after pulling out his J tube. The ER doc replaced it and sent him home. There was no fluoriscopic guidance used, the only imaging was a tubogram afterwards, with contrast, to check placement.

I can't find a CPT that really covers this. If it was a gastrostomy, I would use 43760, but I don't see the equivalent for a jejunostomy.

Any ideas?


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## pharmon

is it the same tube he's putting in place?  or a new tube?


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## jvargocpc

She put in a new tube.


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## pharmon

J-tube replacement of a new tube is 49452.  You can't charge for the guidance on these anyway it's included, and 49451 is used for same tube replacement.


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## jvargocpc

Okay, so three more questions. (I really appreciate the help, by the way)

1. Do I use a 52 modifier on the code since no fluoriscopic guidance was used?

2. Should I be using 49452 since it specifies a gastro-jejunostomy tube or should I use 49451 since it specifies a jejunostomy tube, as this was only a jejunostomy tube?

3. Where would I find the information that shows one of those two codes includes reusing the same tube?

Thanks!


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## pharmon

Do I use a 52 modifier on the code since no fluoriscopic guidance was used?

*You don't have to from what I read.  We never add a 52 because guidance is not charged on it anyway*

2. Should I be using 49452 since it specifies a gastro-jejunostomy tube or should I use 49451 since it specifies a jejunostomy tube, as this was only a jejunostomy tube?
*49452 is for new tube, and 49451 is same tube (same site exhanges) If you go into a new site for replacement, that's a new placement entirely.  *

3. Where would I find the information that shows one of those two codes includes reusing the same tube?
*I have a Coding Strategies Instructions manual and they come on our premises each year to train us.  Their books are the best for radiology help, however most expensive.  I've wanted a set for home, and absolutely can't afford them.  I can't even copy it, and fax it because of their strict copywrite guidelines.  *


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## Mouf1818

The new tube that was put in place, was it through the old tubes tract or a separate tract?  If it was put through  the same tract this would be considered a change, if it's put in in a separate tract this would actually be a placement. a j tube placement=49441, a j tube replacement=49451.  I wouldn't use a -52 mod in either situation.

Amber B.  CPC


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## jvargocpc

Thank you!

Using 49451 makes more sense to me after looking at the CPT descriptions.


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## jdrueppel

Wouldn't the 52 modifier be necessary because the complete definition of CPT code 49451 has not been met?  This code is valued including fluoroscopic guidance so without this compenent of the service it would be reduced services. 

Any other opinions welcomed.  I want to make sure I'm correctly understanding the CPT guidelines. 

Julie, CPC


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## KimberlySherman

I agree with jdrueppel. The 49451 cannot be reported without -52 if the guidance was not used.


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## donnajrichmond

If fluoro guidance was not used you can't use 49451 (or any of the other codes in this section) at all, with or without -52.   When the code description lists a specific type of guidance, then that means that that guidance is not just included, but inherent in the procedure and to use that code you have to use that kind of guidance. 
This case should have been coded with an unlisted code at best, or included in the physician's E & M service. 
See CPT Assistant, July 2010.


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