Radiology Coding Alert

Differentiate between G- and J-tubes to speed payment

If your interventional radiologist places a feeding tube into the small bowel instead of the stomach and you don't know the difference between G-tubes and J-tubes, don't plan on receiving appropriate reimbursement.
 
Take a look at some frequently asked questions to see if you know how to decipher your interventional radiologist's tube-placement notes.

Question 1: What Is the Difference Between a G-Tube and a J-Tube? 
 
The main difference is that the physician inserts the G-tube percutaneously into the stomach, but he inserts a J-tube (percutaneous jejunostomy tube) directly into the jejunum, says Margaret Lamb, RHIT, CPC, Great Falls Clinic, Great Falls, Mont.  Percutaneous gastrostomy tubes (G-tubes) are feeding tubes required by patients unable to consume sufficient calories to meet metabolic needs. Physicians use this technique most often with patients who have impaired swallowing, neoplasms of the esophagus or larynx, and other catabolic conditions.
 
If necessary, due to repeated aspiration of nasogastric tube feedings or other problems, the physician can modify the G-tube technique to allow placement of a jejunostomy tube at the time of the initial procedure or during a later session.

Question 2: How Should I Code G-Tube Placement?

You should report 43750 (Percutaneous placement of gastrostomy tube) for a G-tube placement. In addition, report 74350 (Percutaneous placement of gastrostomy tube, radiological supervision and interpretation) for the radiological supervision and interpretation (RS&I).
 
You may be confused when the interventionalist's notes refer to "buttons" - PEG buttons or "Mickey" buttons. These are smaller, shorter tubes that the physician inserts through established tracts in the skin created by the standard G-tube. The physician uses PEG buttons to replace a standard G-tube after weeks or months when the original tube tract has matured.
 
You should report these procedures using the G-tube replacement codes 43760 (Change of gastrostomy tube) and CPT 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., gastrointestinal system, genitourinary system, abscess], radiological supervision and interpretation), says Stephanie Goodfellow, billing supervisor for Mid-America Gastro-Intestinal Consultants in Kansas City, Mo.

Question 3: How Should I Code a Conversion From G-Tube to J-Tube?

A J-tube is a longer tube that the physician inserts into the small bowel rather than the stomach. If the patient has a G-tube in place but requires a J-tube instead, the physician has to convert it to a J-tube by going beyond the duodenum. You should code the conversion with 43761 (Repositioning of the gastric feeding tube, any method, through the duodenum for enteric nutrition) and 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., gastrointestinal system, genitourinary system, abscess], radiological supervision and interpretation).
  
If the patient requires the conversion to a J-tube due to complications during the 10-day global period following the initial G-tube insertion, you should append modifier    -78 (Return to the operating room for a related procedure during the postoperative period) to 43761. This way, the insurer won't erroneously bundle the conversion into the original G-tube insertion.