You Be the Coder:
Displaced GJ Tube
Published on Mon Apr 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our radiologist replaced a displaced gastrojejunostomy (GJ) tube. How should we code this? Should we use 43761? Is there an RS&I code to report?
Texas Subscriber
Answer: There are a number of opinions. The AMA, which authors the CPT Codes , recommends reporting 43750 (Percutaneous placement of gastrostomy tube). Modifier -78 (Return to the operating room for a related procedure during the postoperative period) is appended if the reinsertion is done within the 10-day global surgical period of the initial placement, and if the initial placement was done by the same interventional radiologist or by another interventionalist within the same group. Code 74350 (Percutaneous placement of gastrostomy tube, radiological supervision and interpretation) should also be assigned.
Others suggest that the correct response to this question depends on exactly what was done. For example, a gastrojejunostomy tube may be displaced out of the small bowel and instead coiled in the stomach, or may be completely dislodged from the gastrointestinal tract. Furthermore, in the latter case, the tract may be maintained by an adjacent gastric tube, or all access to the gastrointestinal tract may be lost and the tract to the stomach may need to be renegotiated. Finally, the tract itself may be well established and readily negotiated, or it may need to be imaged first and then renegotiated.
In the first case, assuming the gastric tube is still in place and/or the GJ tube is coiled in the stomach but still usable, the correct surgical code may be 43761 (Repositioning of the gastric feeding tube, any method, through the duodenum for enteric nutrition) with 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., gastrointestinal system, genitourinary system, abscess], radiological super-vision and interpretation).
In the second case in which gastric access is also lost, but a well-defined tract is present, CPT 43760 * (Change of gastrostomy tube) might be used in addition to the codes detailed above. In more complex cases, you could alternatively use 43750 and 74350 instead of 43760*. In this case, 43761 and 75984 should also be assigned. This latter coding strategy is needed when a double lumen tube or two separate tubes (one G tube and one J tube) are placed with one lumen opening into the stomach and the other in the jejunum. The final positions of both luminal openings must be documented by contrast injection in this latter instance.
If the tract must be imaged by performing a sinogram and negotiating the tract to replace the tubes, 43750 and 20501* (Injection of sinus tract; diagnostic [sinogram]) may be used with 74350 and 76080 (Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation). Again, 43761 and 75984 should also be used.
Because of the differing expert opinions, coders should ask the payer in question for its preference in reporting these procedures.
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