# Contrast injection -NG Tube - Under fluoroscopic guidance water



## Shirleybala (Apr 16, 2009)

Under fluoroscopic guidance water soluble contrast material was carefully injected thro the indwelling naso-gastric tube. 

How to code this procedure


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## msncoder (Apr 16, 2009)

*Contrast injection -NG Tube*

49465 (includes fluoro)


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## msncoder (Apr 16, 2009)

Unless the contrast injection thru NG tube was for the purpose of obtaining a small bowel series which would be 74251


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## Shirleybala (Apr 17, 2009)

49465	Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report The physician injects contrast via a percutaneous approach for the radiological evaluation of existing tubes (gastrostomy, duodenostomy, jejunostomy, gastrojejunostomy, or cecostomy). Image documentation and report are included in this procedure.
49465- is injection procedure for percutaneous gastrostomy and not for naso gastric tube
So only iam having the doubt


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## msncoder (Apr 17, 2009)

Geesh, I really need to stop answering questions late at night because that is the second time I have overlooked a crucial piece of info! 
In the November 2003 CPT Asst on pg 14 this same question was asked and AMA stated that it was appropriate to use CPT 49424 & 76080. I attached a copy of the page just in case you wanted it.


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## Shirleybala (Apr 19, 2009)

Thankyou so much


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## elamathi (Apr 20, 2009)

Hi Anita,


We use 49424/76080 for GJ tube contrast injection until the code 49465 updated.  As you told, the concept is correct for 2003, but now we have seperate codes for GJ tubes, so I feel 49465 is appropriate.

Your thoughts pls

Elamathi CPC


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## msncoder (Apr 20, 2009)

Elamathi,
  As Shirley pointed out, CPT 49465 specifically states Percutaneous approach and since the NG tube is not a percutaneously placed g-tube then I would still utilize 49424/76080 as instructed in 2003. The only way I would feel comfortable billing CPT 49465 for a NG tube would be if the report specifically dictates that the injection itself was performed via a percutaneous approach.


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