General Surgery Coding Alert

Question: Could you please explain the coding process for percutaneous tube insertions like duodenostomy or cecostomy? Also, would the same codes apply when replacing these tubes?

AAPC Forum Participant

Answer: No, you should not use the same codes for placement and replacement of gastrointestinal (GI) tubes. According to Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia, “Ensure the documentation properly describes the type of tube and location of placement to select the correct code. Explain to surgeons that there are different codes for placement and replacement and what key documentation supports correct coding.”

For tube placement, you should choose from 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)

If the surgeon is replacing an existing GI tube, consider using one of these 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)

Avoid: The code for replacement encompasses both the extraction of the old tube and the insertion of the new one. Therefore, there’s no need to use 49441 or 49442 for placement alongside the replacement code 49451 or 49450.