43752 vs 44500/74340 (feeding tubes)


Billings, MT
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Can anyone tell the difference between these two procedures? I've been having a very difficult time trying to code these. I think because my doctors documentation is not always the best. It sounds like a 43752 because he's sticking it through his nose but he's calling it a miller-fredrick tube similar to 44500. The radiology techs put 74340 on the heading of the report. I'm tired of not knowing if I'm really coding them correctly. I have scoured my Coding alerts and can't find an answer to this.
Any information on these would be helpful. Here's an ex:

Placement of nasoduodenal Miller-Fredrick feeding tube:

Clinical history: nourishment

Using viscus lidocaine in the left nostril and flouroscopic guidance, the Miller-Fredrick tube was manipulated through the nose, esophagus and into the stomach. I then manipulated the catheter into the duodenum and I left the tube tip in the fourth portion of the duodenum. I had to use Reglan to pass this feeding tube and it was moderately difficult.

Successful nasoduodenal tube placement.

I hardly ever have to bill for the NG tube because it is bundled into my specialty (anesthesia) but here is how I understand it. 43752 / NG or OG tube is inserted only to the level of the stomach. 44050 / GI tube is placed beyond the stomach into the intestines.

Per your posted documentation this would be 44500/74340 as the duodenum is the first part of the small intestines.

Hope this helps.

Julie, CPC
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NG is temporary, from the nose to the stomach and it is usually short term.
G tube is percutaneous in stomach for a while and G-J is into stomach and advanced into small bowell. J tube is percutaneous and into the jejunum. Reading your post I would say it's a NG tube, temporary and thats what I code it as. Some Dr's are describing the tube brand and that does get confusing to me as well.