CPT HELP

Good Morning!
Could someone tell me what CPT code they would use for this type of procedure? Thanks so much!

Procedure: Upper GI endoscopy
Indications: Replace PEJ tube
Providers:
Referring Provider:
Medicines: Monitored Anesthesia Care
Complications: No immediate complications.

Procedure: After obtaining informed consent, the endoscope was
passed under direct vision. Throughout the procedure, the
patient's blood pressure, pulse, and oxygen saturations
were monitored continuously. The Colonoscope was
introduced through the mouth, and advanced to the
jejunum. The upper GI endoscopy was accomplished without
difficulty. The patient tolerated the procedure well.

Findings:
The esophagus was normal.
The stomach was normal.
The examined duodenum was normal.
A PEJ was seen within the stomach. The site appeared healthy.
The 20F PEJ was removed under endoscopic vision. An externally removable
24 Fr EndoVive Safety gastrostomy tube was lubricated. The guide wire
was passed through the existing PEJ and snared endoscopically. The
endoscope and snare were then removed, pulling the wire out through the
mouth. Removal was easily accomplished. The g-tube was tied to the
guidewire, pulled through the mouth into the stomach and then pulled out
from the stomach through the skin. The bumper was attached to the
gastrostomy tube. The feeding tube was then cut to an appropriate
length. The final position of the gastrostomy tube was confirmed by
relook endoscopy, and skin marking noted to be 2.5 cm at the external
bumper. The final tension and compression of the abdominal wall by the
PEJ tube and external bumper were checked. The tube was capped, and the
tube site was cleaned and dressed.

Impression: - Normal esophagus.
- Normal stomach.
- Normal examined duodenum.
- The PEJ was removed and replaced with an externally
removable 24 Fr PEJ.
- No specimens collected.

Recommendation: - Tube may be used immediately.
- Future replacements require endoscopy with original PEG
tube/bumper. Replacement balloon cannot be used as it
obstructs the small bowel.

Cindy Wensmann, CPC
Cardiac Surgery/Gastroenterology Coding Specialist II
CentraCare Health
320-229-4916 Ext. 71627
wensmannc@centracare.com

Comments

  • Good Afternoon,
    Could someone tell me what CPT code(s) they would use for something like this? I believe I would use 45385 for the snare of the ascending colon polyp and 45380 for the biopsy of the inflammation but what I am wondering is if there is a CPT code for the Chromoscopy that was performed? Thank you so much!


    Findings:
    The perianal and digital rectal examinations were normal.
    The terminal ileum appeared normal.
    A 4 mm polyp was found in the proximal ascending colon. The polyp was
    sessile. The polyp was removed with a cold snare. Resection and
    retrieval were complete.
    A diffuse area of granular inflamed mucosa was found in the rectum and
    in the distal sigmoid colon. Biopsies were taken with a cold forceps for
    histology.
    A patchy area of mildly atrophic and scarred mucosa was found in the
    sigmoid colon, in the descending colon, in the transverse colon and in
    the ascending colon. Contrast chromoscopy with indigo carmine was
    performed. Four biopsies were taken every 10 cm with a cold
    large-capacity forceps from the entire colon for ulcerative colitis
    surveillance. These biopsy specimens from the right colon, left colon,
    transverse colon and rectosigmoid colon were sent to Pathology.

    Impression: - The examined portion of the ileum was normal.
    - One 4 mm polyp in the proximal ascending colon, removed
    with a cold snare. Resected and retrieved.
    - Inflammation in the rectum and in the distal sigmoid
    colon. Biopsied.
    - Atrophic and scarred mucosa in the sigmoid colon, in
    the descending colon, in the transverse colon and in the
    ascending colon. Chromoscopy performed. Biopsied.

    Cindy Wensmann, CPC
    Cardiac Surgery/Gastroenterology Coding Specialist II
    CentraCare Health
    320-229-4916 Ext. 71627
    wensmannc@centracare.com
  • Good Morning!
    Could someone tell me how they would code this? Thanks so much!

    Procedure: After obtaining informed consent, the endoscope was
    passed under direct vision. Throughout the procedure, the
    patient's blood pressure, pulse, and oxygen saturations
    were monitored continuously. The Endoscope was introduced
    through the gastrostomy, and advanced to the third part
    of duodenum. The upper GI endoscopy was accomplished
    without difficulty. The patient tolerated the procedure
    well.

    Findings:
    The stomach was normal.
    The examined duodenum was normal.
    A small caliber scope was placed through the G-tube site and advanced to
    the last portion of the duodenum/proximal jejunum. A wire was passed
    through the scope. The scope was withdrawn over the wire. A 22Fr
    Kimberly Clark GJ tube was advanced over the wire into the last portion
    of the duodenum/proximal jejunum. The wire withdrawn. Fluoro was used to
    ensure proper positioning. The tube was secured at 2.0cm's.

    Impression: - Normal stomach.
    - Normal examined duodenum.
    - GJ tube changed.
    - No specimens collected.

    Cindy Wensmann, CPC
    Cardiac Surgery/Gastroenterology Coding Specialist II
    CentraCare Health
    320-229-4916 Ext. 71627
    wensmannc@centracare.com
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