2025 CPT code 49450
(Active) Effective Date: N/A Revision Date: N/A Surgery - Replacement Procedures on the Abdomen, Peritoneum, and Omentum Surgical Procedures on the Digestive System Feed
Percutaneous replacement of a gastrostomy, cecostomy, or other colonic tube under fluoroscopic guidance, including contrast injection, image documentation, and report.
Modifiers may apply depending on circumstances such as the use of anesthesia (modifier 47), multiple procedures (modifier 51), reduced services (modifier 52), or assistant surgeon involvement (modifier 80 or 81). Refer to the CPT manual for details on modifier use.
Medical necessity is established by the patient's need for nutritional support or medication administration via enteral access when the existing tube is dislodged, malfunctioning, or no longer suitable. Documentation should support the need for replacement.
The physician's responsibility includes preparing the patient, administering anesthesia (if needed), using fluoroscopy to guide the tube replacement, removing the old tube, inserting and securing the new tube, injecting contrast to ensure proper placement, applying dressings, and documenting the procedure and images.
- Surgical Procedures on the Digestive System
- Surgical Procedures on the Digestive System > Replacement Procedures on the Abdomen, Peritoneum, and Omentum
In simple words: The doctor replaces a feeding tube (gastrostomy, cecostomy, or similar) in the stomach or colon through the skin using X-ray guidance.A special dye is used to make sure the new tube is in the right place. Pictures are taken and a report is made.
This CPT code encompasses the percutaneous replacement of an existing gastrostomy, cecostomy, or other colonic tube under fluoroscopic guidance. The procedure involves removing the old tube, inserting a new tube through the existing percutaneous site, and securing it. Contrast material is injected to verify placement, and images are documented.The code includes the image documentation and report generation.
Example 1: A patient's gastrostomy tube becomes dislodged. The physician uses fluoroscopy to replace it through the existing tract., A patient's existing gastrostomy tube malfunctions. The physician replaces it with a new tube under fluoroscopic guidance., A patient requires a new cecostomy tube.The physician performs a percutaneous insertion under fluoroscopic guidance.
* Preoperative assessment and documentation of patient's condition.* Consent form for the procedure.* Anesthesia records (if applicable).* Fluoroscopic images showing tube placement.* Documentation of contrast injection and its flow.* Postoperative assessment of the patient's condition.* Report detailing the procedure and findings.
** Accurate coding requires careful documentation to distinguish between replacement and initial placement, and to note the use of fluoroscopy and contrast.Always verify payer-specific policies and guidelines for proper reimbursement.
- Revenue Code: P6C (Medicare Fee Schedule: MINOR PROCEDURES - OTHER)
- RVU: This information is not provided in the source data.RVUs vary based on geographic location and payer.
- Global Days: The global period for this procedure is not explicitly defined in the provided sources.Further clarification would require consulting payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: The Technical Component (TC) modifier does not generally apply to this code as it usually implies a separately identifiable component of a service. This code already incorporates the technical aspects of the procedure.
- Fee Schedule: Historical fee schedule data is not provided and can vary significantly by payer and location. Consult fee schedules from previous years for historical data.
- Specialties:Gastroenterology, General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center