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Replacing Jejunostomy tube

  1. #1
    Question Replacing Jejunostomy tube
    Medical Coding Books
    I have a patient who came in to our ER after pulling out his J tube. The ER doc replaced it and sent him home. There was no fluoriscopic guidance used, the only imaging was a tubogram afterwards, with contrast, to check placement.

    I can't find a CPT that really covers this. If it was a gastrostomy, I would use 43760, but I don't see the equivalent for a jejunostomy.

    Any ideas?

  2. Default
    is it the same tube he's putting in place? or a new tube?

  3. #3
    Default
    She put in a new tube.

  4. Default
    J-tube replacement of a new tube is 49452. You can't charge for the guidance on these anyway it's included, and 49451 is used for same tube replacement.

  5. #5
    Default
    Okay, so three more questions. (I really appreciate the help, by the way)

    1. Do I use a 52 modifier on the code since no fluoriscopic guidance was used?

    2. Should I be using 49452 since it specifies a gastro-jejunostomy tube or should I use 49451 since it specifies a jejunostomy tube, as this was only a jejunostomy tube?

    3. Where would I find the information that shows one of those two codes includes reusing the same tube?

    Thanks!

  6. Default
    Do I use a 52 modifier on the code since no fluoriscopic guidance was used?

    You don't have to from what I read. We never add a 52 because guidance is not charged on it anyway

    2. Should I be using 49452 since it specifies a gastro-jejunostomy tube or should I use 49451 since it specifies a jejunostomy tube, as this was only a jejunostomy tube?
    49452 is for new tube, and 49451 is same tube (same site exhanges) If you go into a new site for replacement, that's a new placement entirely.

    3. Where would I find the information that shows one of those two codes includes reusing the same tube?
    I have a Coding Strategies Instructions manual and they come on our premises each year to train us. Their books are the best for radiology help, however most expensive. I've wanted a set for home, and absolutely can't afford them. I can't even copy it, and fax it because of their strict copywrite guidelines.

  7. #7
    Default
    The new tube that was put in place, was it through the old tubes tract or a separate tract? If it was put through the same tract this would be considered a change, if it's put in in a separate tract this would actually be a placement. a j tube placement=49441, a j tube replacement=49451. I wouldn't use a -52 mod in either situation.

    Amber B. CPC

  8. #8
    Default
    Thank you!

    Using 49451 makes more sense to me after looking at the CPT descriptions.

  9. #9
    Default
    Wouldn't the 52 modifier be necessary because the complete definition of CPT code 49451 has not been met? This code is valued including fluoroscopic guidance so without this compenent of the service it would be reduced services.

    Any other opinions welcomed. I want to make sure I'm correctly understanding the CPT guidelines.

    Julie, CPC

  10. #10
    Default
    I agree with jdrueppel. The 49451 cannot be reported without -52 if the guidance was not used.

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