Gastrointestinal System (GI)

Gastrointestinal System

Physician Places Oral placement of GI tubes under imaging guidance (fluoroscopic) via the mouth or nose which ends in Stomach (Short NasoGastric Tube) or intestine (Long NasoEnteric Tube). some of the eg are mentioned below,

Nasogastric tubes, 

Dobhoff feeding tubes, 

Enteroclysis tubes, 

Blakemore tubes, and 

Miller-Abbott tubes

Short Nasogastric tube placement Procedure Description:

A nasogastric or orogastric tube is inserted through the nose or mouth of the patient into the stomach. The physician use radiological guidance (Fluoroscopic) to advance the tube into the stomach. The tube is connected to a syringe or a suction pump at the external open end to aspirate or drain the stomach contents.

CPT 43752 - Naso or orogastric tube placement, requiring physician's skill and fluoroscopic guidance (Procedure code includes fluoroscopy guidance) 

 

Long Nasoenteric tube placement Procedure Description:

The provider inserts a long flexible intestinal tube that consists of two channels and a balloon tip down to the small intestine. He uses one of the channels in the tube to aspirate, or withdraw, fluid and air for the temporary management of intestinal obstruction.   

The physician inserts a long gastrointestinal tube through the nose and down to the stomach. A weight in the tip of the tube helps maneuver the tube through the pylorus. The provider inflates the balloon which provides enough bulk to pass the tube into the small intestines. The provider sometime uses the CT or ultrasound to guide the insertion and assure placement of the tube. The provider then uses the second channel of the tube to aspirate, or withdraw, fluid and air from the intestines and relieve the obstruction. After an appropriate period of observation, the provider releases the patient.

CPT 44500 - Introduction of long gastrointestinal tube (eg, Miller-Abbott) 

S&I 74340 - Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopic films with radiological supervision and interpretation.

CPT 43761 - Repositioning of a naso or orogastric feeding tube, through the duodenum for enteric nutrition, If imaging guidance is performed, use CPT 76000

GI TUBE PLACEMENT 

Gastrointestinal tube placement procedure involves percutaneous placement of a tube directly into the stomach or intestine via the skin.

 

Gastrostomy tube Procedure Description:

Patient is appropriately prepped and anesthetized, the physician inserts an orogastric or nasogastric tube and confirms the position by imaging. She insufflates, or blows air into, the stomach. Under fluoroscopic guidance punctures the abdominal wall and inserts a needle then passes a guide wire through it, and pulls the needle out. he places a dilator to allow serial dilatation of part of the body of the stomach. The physician advances a loop catheter into the stomach and injects contrast at each step to ensure proper placement of the tube and patency of the stomach. After securing the tube, he removes all instruments and applies sterile dressings.

CPT 49440 - Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection, image documentation and report.

 

Duodenostomy or jejunostomy tube Procedure Description:
Patient is appropriately prepped and anesthetized, the provider uses fluoroscopic guidance to puncture the abdominal wall. He inserts a needle, passes a guide wire through it, and pulls the needle out. He places a dilator to allow serial dilatation of the tract. He inserts and secures the jejunostomy or duodenostomy tube into the small intestine, stitching it in place. After securing the tube, he removes all instruments and applies sterile dressings.

CPT 49441 - Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection, image documentation and report 

Cecostomy Procedure Description:

Patient is appropriately prepped and anesthetized, the physician place a catheter in the rectum to inflate the colon during the procedure. The physician makes a small incision on the abdominal wall, assessing the position of the cecum or colon under fluoroscopic guidance. After identifying the position, he directly punctures the cecal or colon by inserting a needle and passes a guide wire through the needle under fluoroscopy. After removing the needle and performing dilatation of the tract, the provider inserts the cecostomy or colonic tube and secures it in the intestinal wall. He may inject contrast at each step to improve visualization under fluoroscopic imaging and ensure proper placement of the tube and patency of the cecum or colon. After completion of the procedure, he applies sterile dressings.

CPT 49442 - Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection, image documentation and report.

Note:

All percutaneous gastrointestinal tube placements include the use of Fluoroscopic, Injection of contrast, the images obtained, and the placement of the tube. No need to code S&I separately.

Conversion of gastrostomy tube to gastro-jejunostomy tube procedure description:

Patient is appropriately prepped and anesthetized, the provider uses fluoroscopy to guide placement of a guide wire through the existing gastrostomy tube. The physician removes the gastrostomy tube, uses the existing tract to advance a catheter, and then moves it across the pylorus and into the jejunum. The physician replace the guide wire with a stiffer wire and then use that wire to guide the gastrojejunostomy tube. The physician inject contrast to improve visualization under fluoroscopy and confirm proper tube position in both the jejunum and stomach. Then secures the tube and removes the wires. After completion of the procedure, applies sterile dressings.

CPT 49446 - Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection, image documentation and report