How To Use CPT Code 49440

CPT 49440 describes the percutaneous insertion of a gastrostomy tube under fluoroscopic guidance, including contrast injection(s), image documentation, and report. 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 49440?

CPT 49440 can be used to describe the percutaneous insertion of a gastrostomy tube under fluoroscopic guidance. This procedure is performed by a healthcare provider to help patients with abnormalities of the mouth, esophagus, or stomach, or those with impaired swallowing mechanisms. The provider inserts the gastrostomy tube through the skin using fluoroscopic guidance, ensuring proper placement and patency of the stomach.

2. Official Description

The official description of CPT code 49440 is: ‘Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation, and report.’

3. Procedure

1. The healthcare provider prepares the patient and confirms the position of the orogastric or nasogastric tube using imaging.
2. Under fluoroscopic guidance, the provider punctures the abdominal wall and inserts a needle.
3. A guide wire is passed through the needle, and the needle is removed.
4. A dilator is placed to allow for the serial dilatation of part of the stomach.
5. The provider advances a loop catheter into the stomach and injects contrast at each step to ensure proper placement and patency of the tube.
6. After securing the tube, the provider removes all instruments and applies sterile dressings.

4. Qualifying circumstances

CPT 49440 is performed on patients with abnormalities of the mouth, esophagus, or stomach, or those with impaired swallowing mechanisms. The procedure is typically done percutaneously, meaning through the skin, and under fluoroscopic guidance. It is important to note that CPT 49440 should not be reported if the procedure involves the conversion to a gastro-jejunostomy tube at the time of initial gastrostomy tube placement. In such cases, CPT 49440 should be reported in conjunction with CPT 49446.

5. When to use CPT code 49440

CPT code 49440 should be used when a healthcare provider performs the percutaneous insertion of a gastrostomy tube under fluoroscopic guidance. This code is appropriate for cases where the provider uses contrast injection(s), documents the procedure with images, and provides a report. It is important to review the specific documentation requirements to ensure accurate reporting of CPT 49440.

6. Documentation requirements

To support a claim for CPT 49440, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for gastrostomy tube insertion
• Use of fluoroscopic guidance and contrast injection(s)
• Date of the procedure
• Start and end time of the procedure
• Specific steps performed during the procedure, including the insertion of the guide wire, dilatation, and placement of the loop catheter
• Confirmation of proper placement and patency of the tube
• Any complications or additional interventions
• Images documenting the procedure
• A detailed report summarizing the procedure and its outcomes

7. Billing guidelines

When billing for CPT 49440, ensure that the procedure meets the specific criteria outlined in the code description. The provider should perform the percutaneous insertion of the gastrostomy tube under fluoroscopic guidance, including contrast injection(s), image documentation, and report. It is important to note that CPT 49440 should not be reported if the procedure involves the conversion to a gastro-jejunostomy tube at the time of initial gastrostomy tube placement. In such cases, CPT 49440 should be reported in conjunction with CPT 49446.

8. Historical information

CPT 49440 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Examples

1. A gastroenterologist performing the percutaneous insertion of a gastrostomy tube under fluoroscopic guidance for a patient with esophageal cancer.
2. An interventional radiologist inserting a gastrostomy tube percutaneously under fluoroscopic guidance for a patient with dysphagia.
3. A general surgeon performing the percutaneous insertion of a gastrostomy tube under fluoroscopic guidance for a patient with a neurologic disorder affecting swallowing.
4. An oncologist inserting a gastrostomy tube percutaneously under fluoroscopic guidance for a patient undergoing chemotherapy.
5. An otolaryngologist performing the percutaneous insertion of a gastrostomy tube under fluoroscopic guidance for a patient with head and neck cancer.
6. A pediatric surgeon inserting a gastrostomy tube percutaneously under fluoroscopic guidance for a child with congenital abnormalities of the digestive system.
7. An interventional radiologist performing the percutaneous insertion of a gastrostomy tube under fluoroscopic guidance for a patient with a traumatic injury to the esophagus.
8. A gastroenterologist inserting a gastrostomy tube percutaneously under fluoroscopic guidance for a patient with a chronic swallowing disorder.
9. An interventional radiologist performing the percutaneous insertion of a gastrostomy tube under fluoroscopic guidance for a patient with a progressive neurodegenerative disease.
10. A general surgeon inserting a gastrostomy tube percutaneously under fluoroscopic guidance for a patient with severe malnutrition.