Jejunal tube conversion to a Gastrojejunostomy tube

acw03

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I am having a hard time finding the correct CPT for this procedure. Coder has coded 49446 which I see how they got this by going through our encoder. But I see that it isn't correct. I keep getting an unlisted CPT. needing a little help as to which CPT to use. Here is the note:

The existing jejunostomy tube was cannulated with a guidewire and noted to be
occluded.. The retention balloon was deflated. The existing jejunostomy tube
was removed over the wire. A Kumpe catheter and Bentson wire was advanced into
the stomach. A 0.035 Roadrunner wire was placed and a *22 French
gastrojejunostomy tube was advanced over the guidewire with the distal tip
located in the proximal jejunal lumen. The retention balloon was insufflated
with 10 cc of sterile water and retracted against the anterior gastric wall.
The retention disc was advanced taunt over the ventral abdomen. Minimal
contrast was injected through the jejunal port confirming the tip location in
the jejunum. Contrast was also injected into the gastric port confirming
gastric location. 1000 cc of gastric contents was aspirated. A fluoroscopic
spot image was saved. Both ports were then flushed. A sterile dressing was
applied.
 

Jim Pawloski

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I am having a hard time finding the correct CPT for this procedure. Coder has coded 49446 which I see how they got this by going through our encoder. But I see that it isn't correct. I keep getting an unlisted CPT. needing a little help as to which CPT to use. Here is the note:

The existing jejunostomy tube was cannulated with a guidewire and noted to be
occluded.. The retention balloon was deflated. The existing jejunostomy tube
was removed over the wire. A Kumpe catheter and Bentson wire was advanced into
the stomach. A 0.035 Roadrunner wire was placed and a *22 French
gastrojejunostomy tube was advanced over the guidewire with the distal tip
located in the proximal jejunal lumen. The retention balloon was insufflated
with 10 cc of sterile water and retracted against the anterior gastric wall.
The retention disc was advanced taunt over the ventral abdomen. Minimal
contrast was injected through the jejunal port confirming the tip location in
the jejunum. Contrast was also injected into the gastric port confirming
gastric location. 1000 cc of gastric contents was aspirated. A fluoroscopic
spot image was saved. Both ports were then flushed. A sterile dressing was
applied.
I think your missing a part of the report. Was there percutaneous access into the stomach, or did the tube go from nose to jejunum? I think you need the full report, as the note does not make any sense.
Thanks,
Jim Pawloski, CIRCC
 
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