Gastroenterology Coding Alert

Question: We’ve had some issues when we report unlisted codes 43999 or 44799 to describe GJ or J-tube replacements without fluoroscopic guidance. Although CPT^® has released new codes for G-tube replacements without imaging (43762- 43763), no new codes have been released for GJ or J tubes, so we report the unlisted codes, but we aren’t sure why we’re facing denials for these. Can you advise?

Codify Subscriber

Answer: You’re correct to avoid the G-tube replacement codes 43762-43763 for this service, since you’re asking about a J-tube or GJ-tube rather than a standard G-tube. But your insurer may also be correct to deny 43999 (Unlisted procedure, stomach) and 44799 (Unlisted procedure, small intestine).

Here’s why: Some payers may prefer that you report the CPT^® codes for the tube replacements instead of the unlisted codes. Because the following code descriptors include fluoroscopic guidance, if you utilize these codes for the tube replacement without guidance, you must append modifier 52 (Reduced services) to the codes:

• 49451 (Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report)
• 49452 (Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report)

The question of whether to report the unlisted codes or the 49451-49452 codes with modifier 52 appended will come down to the payer’s preference. If your insurer already denied the unlisted codes, it’s likely that they prefer the modifier instead, but you should check with your payers to find out how they want these services coded.