Proper Coding Means Avoiding Entanglements When Billing J-tubes and G-tubes
Published on Wed Sep 01, 1999
Following various abdominal procedures, patients often are malnourished and the general surgeon will insert a tube to nourish the patient.
Typically, the surgeon will perform a jejunostomy
(J-tube) or a gastrostomy (G-tube), depending on the location of the primary procedure.
When performing the most common type of jejunostomy, CPT 44015 (tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method [list separately in addition to primary procedure]), the surgeon makes an abdominal incision and chooses a section of proximinal jejunum. A jejunostomy tube (J-tube) is then placed in the jejunum and brought out through the abdominal wall. The selected section of jejunum is tacked to the inside of the abdominal wall, and then the incision is closed.
With 43830 (gastrostomy, temporary [tube, rubber or plastic][separate procedure]), the most likely gastrostomy during abdominal surgery, the physician makes a midline incision in the upper abdomen and selects a gastrostomy site on the middle anterior surface of the stomach. Stay sutures are placed and a small stab wound is made between purse string sutures. A gastrostomy tube (G-tube) is inserted and the purse string sutures are tied. The G-tube is withdrawn through a stab wound in the abdominal wall and stay sutures are placed in the posterior fascia. Then the abdominal incision is closed.
Understanding In addition to is Crucial
Although both procedures serve a similar purpose (i.e., to feed the patient) and vary primarily by the site of the tube, they are reimbursed differently by payers.
Gastrostomy (43830) is listed as a separate procedure, which means surgeons cannot bill for it if it took place the same day as another procedure in the upper abdominal or stomach area. For lower abdominal procedures, it is not considered separate and may be billed, according to Arlene Morrow, CPC, a general surgery coding consultant in Tampa, FL.
On the other hand, 44015, the most common type of jejunostomy, is described in CPT 1999 as a list in addition to code, meaning that it should be billed over and above the primary procedure, Morrow says.
So when a jejunostomy is performed during the same day as another procedure, such as a partial colectomy (44140), the code is listed separately and reimbursed at 100 percent of its normal rate (which, as an in addition to code, has already been reduced to be intraoperative only, which means payment is for the procedure only, not for any pre- or post-operative work).
Another important characteristic of in addition to codes is that they cannot be billed on their own, only in conjunction with another procedure. This means that:
44015 may be listed in addition to any procedure code between 40490 to 58999; that is to say, it can be billed along with any abdominal procedure [...]
