Key Points for Coding G-J Tube Placement
CPT coding for gastrojejumostomy (G-J) tube placement via endoscopy is not always straightforward. Gastroenterologists report difficulty in selecting the appropriate CPT codes, including endoscopic G-J tube placement with fluoroscopy to confirm placement and placement when the scope is advanced to the second part of the duodenum.
Following are some key points to remember when coding for these procedures.
- Coding for endoscopic G-J tube placement with fluoroscopy to confirm the placement when the jejunum was not reached and enteroscopy was not the intent of the procedure should be reported using CPT codes 43246 and 43999 if the initial tube placement is done at the same time and if the scope is passed beyond the second portion of the duodenum.
- Report CPT code 49446 if fluoroscopy with dye injection is performed to confirm the tube placement.
- If the gastroenterologist is not personally performing fluoroscopy to check or manipulate the tube position, then code 49446 cannot be reported.
- If the existing tube is changed via the endoscope passed to the duodenum, but not beyond the second portion, then only report code 43235.
- For endoscopic G-J placement when the scope advanced to the second part of the duodenum only and the tube is pushed beyond the stomach, report code 43235, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure).
- Report CPT code 49446 if fluoroscopy with injection of dye is performed to confirm the new tube position.
- Report codes 43235 and 44799 if fluoroscopy was not used or if it was not personally performed by the gastroenterologist.