AR2728
Expert
I am so extremely confused on the appropriate CPT for the following FEGD g-j tube procedures. Both completed on the same patient days apart. I would appreciate advice on appropriate coding and have attached the lengthy op reports-I have omitted the FEGD findings to save space:
Procedure 1:
Procedure: FEGD w/perc placement of jejunostomy tube
Currently presents for upper endo to try to place the tube back out into the small intestine. Scope inserted...The patient had a large u-shaped stomach with the tube on the curvature of the anterior wall, this was curled in the stomach with the tip in the antrum. Tube was pulled back and a silk suture was placed around it, this was grasped and the tube was passed on into the duodenum, to second portion, with withdrawal of the scope pulled the tube back into stomach. Once tube through pylorus, attempts at further passage caused it to loop in the fundus and fall back into stomach. Finally pt was placed in left lateral decubitus position, silk suture was grasped and the tube was passed out through the pylorus, with manipulating the tube was slowly inserted to prevent looping and was passed out through the pylorus into the duodenum. The tip was in duodenum and tube was able to be inserted, visualization revealed tip in duodenum with prox tube curled in stomach, balloon was inflated, external button placed down on skin and tied down, Tube was curled in stomach but tip was in pylorus.
Procedure 2:
FEGD with endoscopic placement of gastrojejunostomy tube
Scope inserted...patients current jejunostomy tube was clogged and curled in the stomach, balloon on the current tube was deflated and the tube was removed. a new MIC tube was placed, the suture on the tip of the tube was grasped with bx forceps passed through the endoscope. the tip of the tube was directed out through the pylorus and into duodenum. Forceps were removed and the scope was pulled back toward the insertion site on the anterior wall of the greater curvature. The tube was then slowly inserted with manipulation with the biopsy forceps on the side of the tube to prevent looping in the stomach. The side of the tube was grasped with bx forceps and the tube was passed up toward the antrum a it was inserted into the stomach. It passed out through the pylorus without resistance and around the c-loop. The entire tube was passed in with the pylorus at about 20 cm. The balloon was inflated and pulled up snugly against the abd wall. Pics taken, external button placed and tied down, etc.
Procedure 1:
Procedure: FEGD w/perc placement of jejunostomy tube
Currently presents for upper endo to try to place the tube back out into the small intestine. Scope inserted...The patient had a large u-shaped stomach with the tube on the curvature of the anterior wall, this was curled in the stomach with the tip in the antrum. Tube was pulled back and a silk suture was placed around it, this was grasped and the tube was passed on into the duodenum, to second portion, with withdrawal of the scope pulled the tube back into stomach. Once tube through pylorus, attempts at further passage caused it to loop in the fundus and fall back into stomach. Finally pt was placed in left lateral decubitus position, silk suture was grasped and the tube was passed out through the pylorus, with manipulating the tube was slowly inserted to prevent looping and was passed out through the pylorus into the duodenum. The tip was in duodenum and tube was able to be inserted, visualization revealed tip in duodenum with prox tube curled in stomach, balloon was inflated, external button placed down on skin and tied down, Tube was curled in stomach but tip was in pylorus.
Procedure 2:
FEGD with endoscopic placement of gastrojejunostomy tube
Scope inserted...patients current jejunostomy tube was clogged and curled in the stomach, balloon on the current tube was deflated and the tube was removed. a new MIC tube was placed, the suture on the tip of the tube was grasped with bx forceps passed through the endoscope. the tip of the tube was directed out through the pylorus and into duodenum. Forceps were removed and the scope was pulled back toward the insertion site on the anterior wall of the greater curvature. The tube was then slowly inserted with manipulation with the biopsy forceps on the side of the tube to prevent looping in the stomach. The side of the tube was grasped with bx forceps and the tube was passed up toward the antrum a it was inserted into the stomach. It passed out through the pylorus without resistance and around the c-loop. The entire tube was passed in with the pylorus at about 20 cm. The balloon was inflated and pulled up snugly against the abd wall. Pics taken, external button placed and tied down, etc.