Gastroenterology Coding Alert

Question: My doctor performed an EGD with biopsy but also removed and then replaced a J-Tube. This was done without fluoroscopy. Could you please advise me on how to code this? I was looking at CPT^® code 49451 but this specifically states “under fluoroscopic guidance” so I am uncomfortable using this code. Any help would be greatly appreciated.

Wisconsin Subscriber

Answer: There is no specific code for replacing a pre-existent J tube; therefore, unlisted code 44799(Unlisted procedure, intestine) may be reported.

When reporting an unlisted code to describe a procedure or service, you need to submit supporting documentation (e.g., a procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.

Alternatively, the intensity of the service may be reflected in the “procedural risk” consideration of the medical decision-making component of the evaluation and management service.

Note: If the procedure was performed without imaging guidance, you cannot choose to report the CPT^® code that includes imaging guidance. For this reason, as you have pointed out, you cannot report 49451 (Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection[s], image documentation and report) to report the change of the jejunostomy tube wherein your gastroenterologist did not perform the procedure under fluoroscopic guidance.