General Surgery Coding Alert

Question: Our local Medicare carrier is denying +44015 when performed during the same session as 48150 because, according to the explanation of benefits, the related or qualifying claim/service was not paid or identified on the claim. Should I be using 44300 instead?

Virginia Subscriber

Answer: The denial should be appealed.
Code +44015 (tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method [list separately in addition to primary procedure]) is not limited to a particular procedure, says Marcella Bucknam, CPC, billing and compliance manager with the department of surgery at the University of Nebraska Medical Center in Omaha. Both +44015 and 48150 (pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy [Whipple-type procedure]; with pancreatojejunostomy) are abdominal procedures, but +44015 is an add-on code specifically for use when a feeding tube is installed during or following a major abdominal procedure (e.g., 48150).

Code 44300 (enterostomy or cecostomy, tube [e.g., for decompression or feeding][separate procedure]) is a separate procedure, meaning it shouldnt be used if another abdominal procedure (e.g., 48150) has been performed. Furthermore, CPT instructs surgeons to code to the highest level of specificity, and +44015 more specifically describes the insertion of a J-tube than 44300.

Placement of a feeding tube is usually necessary following 48150 because taking food orally too soon could disrupt the effects of the surgery. Therefore, based on the information you provide, +44015 would be appropriate.