Gastroenterology Coding Alert

Question: The physician's chart says, "The stomach was inflated with air via the nasogastric tube. The stomach was punctured above the colon under fluoroscopic guidance. The tract was serially dilated and a gastrostomy tube was placed utilizing pull technique. The balloon was inflated and intragastric placement was confirmed with contrast injection. The wound was dressed." How should I code the procedure based on this note?

Michigan Subscriber

Answer: You simply should use the all-in-one code 49440 (Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection[s], image documentation and report) for this percutaneous procedure.

What happens: The physician punctures the abdominal wall from outside the body and inserts a device under fluoroscopic or ultrasound guidance. This allows the physician to pull the stomach up to the abdominal wall and then insert the tube percutaneously without using an endoscope.

Mind your CPT® bundles carefully. For instance, do not report 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) with 49440 because this note doesn't support reporting an endoscopy code (43246), and 49440 includes all of the components described in this note.

Tidbit: The doctor places the gastrostomy tube, or G-tube, into the stomach for long-term food, fluid, and medication administration. The most common type is a percutaneous endoscopic gastrostomy (PEG) tube.