Gastroenterology Coding Alert

Question: Could you please clarify how to code for percutaneous insertion of tubes, such as duodenostomy or cecostomy, and whether we should report the same codes for replacing the tube?

Missouri Subscriber

Answer: You should not use the same codes for placement and replacement of gastrointestinal (GI) tubes.

For tube placement, choose one of the following codes based on GI anatomic site:

• 49441 (Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report)
• 49442 (Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report)
• When the surgeon replaces an existing GI tube, you might use one of the following codes:
• 49451 (Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report)
• 49450 (Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report)

Note: The replacement code includes both removal of the old tube and placement of the new tube. In other words, the replacement codes include the work of initial placement, so it would be considered double-dipping to bill for both. Therefore, you can’t list 49441 or 49442 for placement in addition to 49451 or 49450.