Radiology Coding Alert

Count on 43760 for your claims? Not so fast CPT 2008 is offering up some of the gastrostomy tube changes you've been hoping for -- but not all of them. Here's what's in store for your percutaneous jejunostomy claims, gastro-jejunostomy claims and more in 2008. Celebrate New Percutaneous Jejunostomy Code CPT 2008 deletes 43750 (Percutaneous placement of gastrostomy tube) and replaces it with three new codes that help radiologists more precisely describe insertion of gastrostomy (49440), duodenostomy or jejunostomy (49441), or cecostomy or other colonic (49442) tubes: • 49440 -- Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report • 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. Helpful addition: Interventional radiologists are performing an increasing number of percutaneous jejunostomies (49441), so CPT 2008 adding a specific code for this procedure is very helpful, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. For 2007 services, practices used either 43750 or 43999 (Unlisted procedure, stomach) for this procedure. Include RS&I: All of the above insertions take place "under fluoroscopic guidance including contrast injection(s), image documentation and report," and you therefore would not report this service separately, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program. Because fluoro is inherent in the new codes, CPT 2008 deletes 74350 (Percutaneous placement of gastrostomy tube, radiological supervision and interpretation), which you used in 2007 for fluoroscopic guidance for tube placement, Miller says. Replace Your 2007 Tube Replacement Options If your practice or facility is like that of Marylin Brinkman, CPC, with Clarian Health in Indiana, you're far more likely to replace tubes than place them. Stay alert: CPT 2008 also introduces three new codes for gastrostomy tube replacement: • 49450 -- Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoro-scopic guidance including contrast injection(s), image documentation and report • 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. Imaging included in replacements, too: As with insertion codes 49440-49442, replacement codes 49450-49452 include fluoroscopic guidance. To reflect this, the AMA has revised 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation) to remove reference to the gastrointestinal system, [...]