How To Use CPT Code 49460

CPT 49460 describes the mechanical removal of obstructive material from a feeding or drainage tube in the stomach or intestines, under fluoroscopic guidance. 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 49460?

CPT 49460 can be used to describe the procedure of mechanically removing obstructive material from a feeding or drainage tube in the stomach or intestines. This code is used when the provider uses fluoroscopic guidance to remove the blockage and restore flow through the tube. The provider may also inject contrast material to improve visualization during the procedure.

2. Official Description

The official description of CPT code 49460 is: ‘Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed, image documentation and report.’

3. Procedure

1. The provider prepares the patient and removes the sutures from the tube site.
2. Under fluoroscopic guidance, the provider injects contrast material through the tube to check for obstruction.
3. The provider identifies the size and position of the blockage by observing the flow of contrast and the flow pattern in the image.
4. Using fluoroscopic guidance, the provider inserts an appropriate instrument, such as a balloon tip or loop guidewire, through the tube to dislodge the obstructive material.
5. The provider removes all the material and flushes the tube to ensure it is fully functioning.
6. The provider anchors the tube and applies a new dressing.
7. To confirm that the tube is fully functioning, the provider injects contrast material again and documents the images produced.

4. Qualifying circumstances

CPT 49460 is performed when there is obstructive material in a feeding or drainage tube in the stomach or intestines that needs to be mechanically removed. This code is used when the procedure is performed under fluoroscopic guidance, and contrast injection(s) may be performed to aid in visualization. It is important to note that CPT 49460 should not be reported in conjunction with codes 49450, 49451, or 49452.

5. When to use CPT code 49460

CPT code 49460 should be used when a provider performs the mechanical removal of obstructive material from a feeding or drainage tube in the stomach or intestines under fluoroscopic guidance. This code should not be used when replacing the tube. If percutaneous contrast injection is performed for radiological evaluation of an existing tube, CPT code 49465 should be used.

6. Documentation requirements

To support a claim for CPT 49460, the provider must document the following information:

• Images produced by the fluoroscopic guided imaging technique
• Report of the procedure, including details of the obstruction, the size and position of the blockage, and the instrument used for removal
• Date and time of the procedure
• Documentation of any contrast injection(s) performed
• Confirmation of tube functionality after removal of the obstructive material

7. Billing guidelines

When billing for CPT 49460, ensure that the procedure is performed under fluoroscopic guidance and includes contrast injection(s) if performed. It is important to note that CPT 49460 should not be reported in conjunction with codes 49450, 49451, or 49452. For percutaneous contrast injection of an existing tube, CPT code 49465 should be used.

8. Historical information

CPT 49460 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 provider removes obstructive material from a gastrostomy tube in a patient with impaired flow.
2. Under fluoroscopic guidance, a provider dislodges obstructive material from a jejunostomy tube in a patient with feeding difficulties.
3. A provider uses fluoroscopic guidance to remove obstructive material from a cecostomy tube in a patient with drainage issues.
4. Using contrast injection and fluoroscopic guidance, a provider clears an obstruction from a gastrojejunostomy tube in a patient with feeding complications.
5. A provider mechanically removes obstructive material from a duodenostomy tube under fluoroscopic guidance in a patient with drainage problems.
6. Using fluoroscopic guidance, a provider removes obstructive material from a colonic tube in a patient with impaired flow.
7. A provider dislodges obstructive material from a gastrostomy tube under fluoroscopic guidance in a patient with feeding difficulties.
8. Using contrast injection and fluoroscopic guidance, a provider clears an obstruction from a jejunostomy tube in a patient with drainage issues.
9. A provider mechanically removes obstructive material from a cecostomy tube under fluoroscopic guidance in a patient with impaired flow.
10. Under fluoroscopic guidance, a provider dislodges obstructive material from a gastrojejunostomy tube in a patient with feeding complications.