How To Use CPT Code 49450

CPT 49450 describes the percutaneous replacement of a gastrostomy or cecostomy tube under fluoroscopic guidance, including contrast injection(s), image documentation, and a 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 49450?

CPT 49450 can be used to describe the percutaneous replacement of a gastrostomy or cecostomy tube under fluoroscopic guidance. This procedure involves the provider replacing the existing tube through the skin using fluoroscopy to guide the process. The purpose of this procedure is to exchange the tube when the existing one becomes dislodged or no longer functions properly.

2. Official Description

The official description of CPT code 49450 is: ‘Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation, and report.’

3. Procedure

1. The provider preps and anesthetizes the patient appropriately.
2. Using fluoroscopy, the provider guides the replacement of the previous gastrostomy, cecostomy, or other colon tube.
3. The provider removes any sutures and gently pulls out the existing tube.
4. A new tube is advanced into position through the existing percutaneous site, and the retention device is secured internally.
5. Contrast may be injected at each step to ensure proper placement and free flow through the new tube.
6. After completing the procedure, the provider applies sterile dressings.
7. The procedure includes documentation of the images produced by the fluoroscopically guided imaging technique and a report.

4. Qualifying circumstances

This procedure is performed when there is a need to replace a gastrostomy or cecostomy tube that has become dislodged or is no longer functioning properly. The replacement is done percutaneously, meaning through the skin. Fluoroscopic guidance is used to ensure accurate placement of the new tube. The procedure may also involve the injection of contrast to confirm proper placement and free flow through the tube.

5. When to use CPT code 49450

CPT code 49450 should be used when a provider performs the percutaneous replacement of a gastrostomy or cecostomy tube under fluoroscopic guidance. This code is appropriate when the existing tube needs to be replaced due to dislodgement or malfunction. It should not be used when the replacement is performed without imaging or endoscopic guidance or when revision of the gastrostomy tract is required.

6. Documentation requirements

To support a claim for CPT 49450, the provider must document the following information:

• Patient’s diagnosis and the need for tube replacement
• Use of fluoroscopic guidance during the procedure
• Date and time of the procedure
• Specific details of the replacement process
• Injection of contrast, if performed
• Images produced by fluoroscopy
• Report summarizing the procedure and findings

7. Billing guidelines

When billing for CPT 49450, ensure that the procedure meets the criteria for percutaneous replacement of a gastrostomy or cecostomy tube under fluoroscopic guidance. It is important to document the use of fluoroscopy and any contrast injections performed during the procedure. CPT code 49450 should not be reported if the replacement is performed without imaging or endoscopic guidance or if revision of the gastrostomy tract is required. It is also important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 49450 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 patient with a dislodged gastrostomy tube undergoes percutaneous replacement under fluoroscopic guidance.
2. A cecostomy tube that is no longer functioning properly is replaced percutaneously using fluoroscopy.
3. A provider exchanges a gastrostomy tube for a patient who requires a larger size, performing the replacement under fluoroscopic guidance.
4. A patient with a malfunctioning colon tube undergoes percutaneous replacement under fluoroscopic guidance.
5. A gastrostomy tube is replaced percutaneously for a patient with a blocked tube, using fluoroscopy to guide the replacement.
6. A provider performs the percutaneous replacement of a cecostomy tube for a patient with a dislodged tube, using fluoroscopic guidance.
7. A gastrostomy tube is replaced percutaneously for a patient with a leaking tube, with the procedure guided by fluoroscopy.
8. A cecostomy tube is exchanged for a patient who requires a different type of tube, with the replacement performed percutaneously under fluoroscopic guidance.
9. A provider replaces a gastrostomy tube for a patient with a broken tube, using fluoroscopy to guide the replacement.
10. A patient with a malfunctioning colon tube undergoes percutaneous replacement under fluoroscopic guidance.