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Coding for Open G-tube

  1. #1
    Default Coding for Open G-tube
    Medical Coding Books
    Please help with following. The only code I find is 49440 which is insertion of G-tube percutaneous and this was done as an open procedure.


    Operation: Open G tube

    Procedure: Patient placed insupine position with administration of general endotracheal anesthesia. Just under the xiphoid the midline abdomen was opened down throught the fascia and periueum. There was no evidence of abscess or puss in this region.

    The stomach was noted to be above the rib cage. It was grasped with a Babcock and brought down and noted to easily reach the abdominal wall without significant tension. Two pursestrings of Vicryl were placed and entrance into the stomach was performed and passage of the suction into the stomach gastric contents was noted. A #28 French Malecot was secured throught this openeing, pursestrings were secured and it was irrigated with saline and returning gastric contents.

    It was then through an incision in the abdominal wall was passed through the abdominal wall, secured with 3-0 Prolene and the gastrick serosa was secured to the peritoneum with four-quadrant silk stitches and the midline fascia was then closed with #1 Maxon, the skin was approximated with staples, sterile dressings were applied. The G-tube was placed to Foley gravity and the patient was extubated and brought to the Recovery Room in good condition.


    Thank you in advance for any help with this.

  2. #2
    Default
    Quote Originally Posted by amymorgan View Post
    Please help with following. The only code I find is 49440 which is insertion of G-tube percutaneous and this was done as an open procedure.


    Operation: Open G tube

    Procedure: Patient placed insupine position with administration of general endotracheal anesthesia. Just under the xiphoid the midline abdomen was opened down throught the fascia and periueum. There was no evidence of abscess or puss in this region.

    The stomach was noted to be above the rib cage. It was grasped with a Babcock and brought down and noted to easily reach the abdominal wall without significant tension. Two pursestrings of Vicryl were placed and entrance into the stomach was performed and passage of the suction into the stomach gastric contents was noted. A #28 French Malecot was secured throught this openeing, pursestrings were secured and it was irrigated with saline and returning gastric contents.

    It was then through an incision in the abdominal wall was passed through the abdominal wall, secured with 3-0 Prolene and the gastrick serosa was secured to the peritoneum with four-quadrant silk stitches and the midline fascia was then closed with #1 Maxon, the skin was approximated with staples, sterile dressings were applied. The G-tube was placed to Foley gravity and the patient was extubated and brought to the Recovery Room in good condition.


    Thank you in advance for any help with this.
    I had the same problem and I ended up using 49440.
    CRC CPC

  3. #3
    Location
    Temple, TX
    Posts
    16
    Default
    The problem with using 49440 is it includes the use of fluroscopy, but neither one of your providers used fluroscopy to assist with the placement of the G-Tube.

    I have used 43282- Gastrostomy, open; with construction of gastric tube (eg, Janeway procedure) (The physician constructs a permanent gastrostomy for instillation of nutrients. After a small midline upper abdominal incision, the physician creates a flap with its base at the greater curvature of the stomach. The flap is converted into a tube by closure of the stomach incision. The tube is brought through the skin surface via a stab wound or tunnel. The end of the tube is everted slightly and sutured to the skin. The abdominal incision is closed with sutures.)

    I hope this helps!

  4. Default
    What about modifier 52? If fluoroscopy wasn't used, you could charge as a reduced service.

    ~L
    CPC, CGSC, COSC

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