Radiology Coding Alert

Confusion over coding the various scenarios inherent with placement, repositioning and exchange of gastrostomy and gastrojejunostomy tubes can be avoided by using the correct codes in response to specific patient situations.

Billing for Placement of New Tubes

Placement of a new gastrostomy tube entails the physician making a small incision through the skin and fascia of the patients abdomen, according to Cindy C. Parman, CPC, CPC-H, of Coding Strategies, Inc. in Atlanta, a firm that supports 1,000 radiologists, 50 radiation oncologists and 300 physicians from other specialty areas. Parman referred to MediCodes Coders Desk Reference. A large bore needle with a suture attached is passed through this incision into the lumen of the stomach. The physician then inserts a snare through the patients mouth and esophagus. This device is used to grab the needle, suture the stomach and pull both up and out the mouth. The gastrostomy tube is then connected to the suture and passed through the mouth, down to the stomach and out the stomach wall. Sutures then hold the gastrostomy tube in place.

Correct coding for this initial placement is 43750 (percutaneous placement of gastrostomy tube). Radiologic supervision and interpretation for this procedure is 74350 (percutaneous placement of gastrostomy tube, radiological supervision and interpretation).

The procedure for placement for a gastrojejunostomy (G-J) tube is similar, but coders must be aware that either a single- or dual-lumen jejunostomy tube may be introduced. Physicians will make an abdominal incision and mobilize the small bowel. A long intestinal tube is placed into the lumen of the proximal small bowel and threaded through the full length of the small intestine. The tube is brought out through the abdominal wall and the jejunum at the site of the tube is anchored to the inside of the abdominal wall.

The Society for Cardiovascular and Interventional Radiology (SCVIR) in its Coding Users Guide notes the following alternative coding scenario for new gastrojejunostomy tube placement: 43750 and CPT 44373 (small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube). These would be accompanied by radiological supervision and interpretation code 74355 (percutaneous placement of enteroclysis tube, radiological supervision and interpretation). If the procedure involves a dual lumen, 74350 should be added.

Coding Alert: Various states and carriers may recommend different coding approaches for G-J tubes. We strongly advise that you check with your local medical directors to determine their policies.

Converting and Changing GI Tubes Coding

In some instances, the radiologist will be called upon to convert an indwelling gastrostomy [...]