How To Use CPT Code 49451

CPT 49451 describes the replacement of a duodenostomy or jejunostomy tube, percutaneous, 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 49451?

CPT 49451 can be used to describe the replacement of a duodenostomy or jejunostomy tube. This procedure is performed percutaneously, meaning it is done through the skin, under fluoroscopic guidance. The provider uses fluoroscopy, a live X-ray, to guide the replacement of the existing tube. Contrast may be injected to ensure proper placement and to check for any obstructions. The procedure also includes image documentation and a report.

2. Official Description

The official description of CPT code 49451 is: ‘Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation, and report.’

3. Procedure

1. The provider preps and anesthetizes the patient.
2. Using fluoroscopy, the provider guides the replacement of the existing duodenostomy or jejunostomy tube.
3. Any sutures are removed, and the existing tube is gently pulled out.
4. A new tube is advanced into position through the abdominal wall using the existing percutaneous site.
5. The retention device is secured internally.
6. Contrast may be injected at each step to ensure proper placement and free flow through the new tube.
7. After the procedure, sterile dressings are applied.

4. Qualifying circumstances

CPT 49451 is performed when there is a need to replace an existing duodenostomy or jejunostomy tube. This may be necessary when the current tube becomes dislodged or is no longer functioning properly. The procedure is typically performed under fluoroscopic guidance, which allows the provider to visualize the placement of the new tube. The use of contrast may be necessary to ensure proper positioning and to check for any obstructions.

5. When to use CPT code 49451

CPT code 49451 should be used when a provider performs the replacement of a duodenostomy or jejunostomy tube percutaneously, under fluoroscopic guidance. This code includes the injection of contrast, image documentation, and a report. It is important to note that this code should not be reported if other codes, such as CPT codes 49450 or 49452, have already been performed within the same session.

6. Documentation requirements

To support a claim for CPT 49451, the provider must document the following information:

• Reason for the replacement of the duodenostomy or jejunostomy tube
• Details of the fluoroscopic guidance used during the procedure
• Injection of contrast, if performed, and any findings related to tube placement or obstructions
• Image documentation of the procedure
• A detailed report of the replacement procedure

7. Billing guidelines

When billing for CPT 49451, ensure that the procedure meets the criteria outlined in the official description. The use of fluoroscopic guidance and contrast injection(s) should be documented. It is also important to note that CPT 49451 should not be reported if other related codes have already been performed within the same session. Review the specific billing guidelines provided by the payer to ensure accurate reporting and reimbursement.

8. Historical information

CPT 49451 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with a dislodged duodenostomy tube undergoes a percutaneous replacement procedure under fluoroscopic guidance. Contrast is injected to ensure proper placement, and images are documented. A report is generated detailing the procedure.
2. A jejunostomy tube is no longer functioning properly in a patient. The provider performs a percutaneous replacement procedure using fluoroscopic guidance. Contrast is injected, and images are documented. A report is generated.
3. A patient with a duodenostomy tube experiences an obstruction. The provider performs a percutaneous replacement procedure under fluoroscopic guidance. Contrast is injected to check for obstructions, and images are documented. A report is generated.
4. A jejunostomy tube needs to be replaced in a patient. The provider performs a percutaneous replacement procedure using fluoroscopic guidance. Contrast is injected, and images are documented. A report is generated.
5. A duodenostomy tube becomes dislodged in a patient. The provider performs a percutaneous replacement procedure under fluoroscopic guidance. Contrast is injected to ensure proper placement, and images are documented. A report is generated.
6. A patient requires the replacement of a jejunostomy tube. The provider performs a percutaneous replacement procedure using fluoroscopic guidance. Contrast is injected, and images are documented. A report is generated.
7. A duodenostomy tube needs to be replaced in a patient. The provider performs a percutaneous replacement procedure under fluoroscopic guidance. Contrast is injected to check for obstructions, and images are documented. A report is generated.
8. A patient with a malfunctioning jejunostomy tube undergoes a percutaneous replacement procedure using fluoroscopic guidance. Contrast is injected, and images are documented. A report is generated.