How To Use CPT Code 44500

CPT 44500 describes the introduction of a long gastrointestinal tube, such as the Miller-Abbott tube, as a separate procedure. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 44500?

CPT 44500 can be used to describe the introduction of a long gastrointestinal tube, specifically the Miller-Abbott tube, as a separate procedure. This code is used when a healthcare provider inserts a long flexible intestinal tube with two channels and a balloon tip down to the small intestine. One channel is used to aspirate fluid and air for temporary management of intestinal obstruction.

2. Official Description

The official description of CPT code 44500 is: ‘Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure).’ This code does not include radiological supervision and interpretation, which should be reported separately using code 74340. For naso- or oro-gastric tube placement, use code 43752.

3. Procedure

1. The healthcare provider inserts a long gastrointestinal tube through the nose and down to the stomach.
2. A weight in the tip of the tube helps maneuver it through the pylorus.
3. The provider inflates the balloon at the tip of the tube to provide enough bulk for it to pass into the small intestines.
4. CT or ultrasound may be used to guide the insertion and ensure proper placement of the tube.
5. The provider uses the second channel of the tube to aspirate fluid and air from the intestines, relieving the obstruction.
6. After observation, the patient is released.

4. Qualifying circumstances

CPT 44500 is performed when a patient requires the temporary management of intestinal obstruction. The patient may or may not be sedated during the procedure. The healthcare provider must use a long gastrointestinal tube, such as the Miller-Abbott tube, and insert it through the nose and down to the stomach. The balloon at the tip of the tube is inflated to facilitate passage into the small intestines. CT or ultrasound may be used for guidance. The provider then uses the second channel of the tube to aspirate fluid and air from the intestines to relieve the obstruction.

5. When to use CPT code 44500

CPT code 44500 should be used when a healthcare provider performs the introduction of a long gastrointestinal tube, such as the Miller-Abbott tube, as a separate procedure. It is important to note that this code does not include radiological supervision and interpretation, which should be reported separately using code 74340. For naso- or oro-gastric tube placement, use code 43752.

6. Documentation requirements

To support a claim for CPT 44500, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for the introduction of a long gastrointestinal tube
• Specific details about the procedure, including the type of tube used (e.g., Miller-Abbott)
• Date of the procedure
• Any guidance used during the procedure, such as CT or ultrasound
• Details about the aspiration of fluid and air from the intestines
• Observation period and patient release
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 44500, ensure that the procedure is performed as a separate procedure and not included in other services. It is important to report radiological supervision and interpretation separately using code 74340 if applicable. Naso- or oro-gastric tube placement should be reported using code 43752. It is crucial to follow the specific guidelines provided by the payer and ensure accurate documentation to support the claim.

8. Historical information

CPT 44500 was added to the Current Procedural Terminology system on January 1, 1994. There have been no updates to the code since its addition.

9. Examples

1. A gastroenterologist performing the introduction of a long gastrointestinal tube, such as the Miller-Abbott tube, for a patient with intestinal obstruction.
2. An interventional radiologist using fluoroscopic guidance to assist in the placement of a long gastrointestinal tube for a patient with a complex obstruction.
3. A general surgeon performing the introduction of a long gastrointestinal tube for a patient with a known small intestine obstruction.
4. A gastroenterologist using ultrasound guidance to ensure proper placement of a long gastrointestinal tube for a patient with an obstructed small intestine.
5. An emergency medicine physician performing the introduction of a long gastrointestinal tube for a patient with acute intestinal obstruction.
6. A pediatric gastroenterologist using a long gastrointestinal tube to relieve an obstruction in a young patient.
7. An interventional radiologist performing the introduction of a long gastrointestinal tube for a patient with a recurrent intestinal obstruction.
8. A surgical oncologist using a long gastrointestinal tube to manage an obstruction in a patient with advanced cancer.
9. A gastroenterologist performing the introduction of a long gastrointestinal tube for a patient with a postoperative intestinal obstruction.
10. An interventional radiologist using fluoroscopic guidance to assist in the placement of a long gastrointestinal tube for a patient with a chronic intestinal obstruction.