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Thread: GI tube help

  1. #1

    Question GI tube help

    AAPC: Back to School
    I've got a procedure one of my radiology doctors did and I can't make heads or tails of it. I'm not sure if there's a code that covers what he appears to have done. I was just wondering if anyone could give me some ideas. This patient has a feeding tube (either in his mouth or nose) extending into his duodenum. Thanks!

    History: Failure to thrive.

    Technique and findings: The procedure was discussed with the
    patient's parents. They were present for the procedure. Under
    fluoroscopy, the patient's existing small bore feeding tube was then
    pulled back so the tip was in the stomach. Initially, there was
    difficulty injecting the barium through the feeding tube, however was
    noted the tube was kinked upon itself as multiple loops had to be
    pulled back. Thin barium was instilled through the feeding tube into
    the stomach under under intermittent fluoroscopic visualization.
    Contrast pooled in the fundus and the patient was placed in a right
    lateral decubitus position. Once contrast extended to the antrum, it
    rapidly filled the duodenum. Gastroesophageal reflux was identified
    to the mid thoracic esophagus. The tube was flushed with a small
    amount of water. Then, the stylet for a new feeding tube was inserted
    into the existing feeding tube and it was repositioned with its tip
    at the junction of the second and third duodenum. It was affixed to
    the patient's skin. He tolerated procedure well. No immediate
    complications. Additionally, limited fluoroscopy was performed to
    identify the left-sided PICC line, the tip overlies left
    brachiocephalic vein just left of midline.

    1. When the thin barium was placed into the antrum, it flowed freely
    and quickly into the duodenum without evidence of obstruction.
    Gastroesophageal reflux was noted during this study as described.
    2. It was noted that a left-sided PICC line extends to the left
    brachiocephalic vein as described.

  2. #2


    Repositioning of the tube is an E&M code. Maybe 49400 could be used for the injection of barium. I'm not saying that's the correct code but suggesting you find more info about it to see if it would be appropriate.

    Diane Huston, CPC,RCC

  3. #3



    My suggestion on this is we can code 43761 for repositioning.

    Dont think 49400 can be coded.

    Correct me if iam wrong

    Joseph Amalraj CPC-H

  4. #4


    I think we can use 49424 and 76080

  5. #5



    They assesed the tube and also repositioned.

    Joseph Amalraj Antonisamy CPC-H

  6. #6


    I think those codes are only for gastrostomy procedures. In this case, it's an NG tube.

    Diane Huston, CPC,RCC

  7. #7


    Thanks for the help!

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