# Insertion Of NG feeding tube



## PRINCESSMHH

The GI doctor performed a EGD in the endoscopy suite and inserted a NG feeding tube.  Please advise on cpt code for this procedure.  I know the one for the EGD with PEG placement...but need help with this one.  Any advice advice would be greatly appreciated.


Complicated


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## cfullum

The only code that you are going to us for this is 43246.


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## PRINCESSMHH

*NG tube placement*

43246....I thought that was for direct placement of a PEG tube...not sure....look at code 44500....

The more that I look at it I just get confused...will you look at the code too?  Tell me what you think?   Thanks for your help!  

Encouraged


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## mhcpc

43246 is for PEG placement.  Look at 43752.


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## PRINCESSMHH

*EGD with NG tube feed placement*

Do you think that code 43752 would also be applicable to the EGD???

Thanks


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## mhcpc

If he performed a diagnostic EGD, removed the scope, and then dropped the NG tube using fluoroscopic guidance you could use a 59 modifier and I would send the note. 

43752 requires a physicians skill and fluoroscopic guidance.  44500 is not included in the EGD, but according to the information I have been able to find, the tube is passed into the small bowel.


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## edajade1129

43241


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## orazzals

PRINCESSMHH said:


> Do you think that code 43752 would also be applicable to the EGD???
> 
> Thanks




Code Descriptor
Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report) 
Notes:
(Do not report 43752 in conjunction with critical care codes 99291-99292, neonatal critical care codes 99468, 99469, pediatric critical care codes 99471, 99472 or low birth weight intensive care service codes 99478, 99479) 

(For percutaneous placement of gastrostomy tube, use 49440) 

(For enteric tube placement, see 44500, 74340) 

Lay Term
A nasogastric or orogastric tube is inserted through the nose (naso?) or mouth (oro?) of the patient into the stomach via the mouth and esophagus. The physician may use radiological guidance to advance the tube to the stomach. This procedure is mainly done to aspirate stomach contents for diagnostic or therapeutic purpose, to prevent aspiration and vomiting in trauma patients, and for enteral feeding. For patients with poisoning or drug overdose, the tube is used to remove the harmful substance from the body by draining the contents of the stomach. The tube is connected to a syringe or a suction pump at the external open end to aspirate or drain the stomach contents.

Clinical Responsibility
The physician sprays or applies Xylocaine to the patient's nostril or throat after putting the patient in an upright position that allows better alignment of the stomach and neck. A 2% Xylocaine lubricant gel may be applied to the tube to desensitize the passage. The tube is put either through one of the nostrils or through the mouth and advanced under fluoroscopic guidance. The patient is allowed to swallow small sips of chilled water to facilitate the progress of the tube. Great care must be taken to ensure that the tube has not passed through the larynx into the trachea and down into the bronchi.
Once the tube reaches the stomach, it is secured with an adhesive tape or a tube holder. The physician connects the open end of the tube to a syringe or a low?power suction pump to aspirate the contents of the stomach. Any adverse reaction such as respiratory distress or cough may need withdrawal of the tube.
The physician may check the pH status (acidity) of the stomach content when considering enteral medication or feeding.
Fluoroscopic guidance and related image documentation and report during the procedure are included in the code 43572.


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