2025 CPT code 49446
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Conversion of gastrostomy tube to gastrojejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation, and report.
Modifiers may be applicable depending on the circumstances of the procedure.Common modifiers include 22 (Increased Procedural Services), 52 (Reduced Services), 59 (Distinct Procedural Service), 76 (Repeat Procedure by Same Physician), and 77 (Repeat Procedure by Another Physician).
Medical necessity is established by the underlying condition requiring enteral feeding and the inability to tolerate gastric feeding due to a documented medical condition such as gastroparesis, GERD with aspiration risk, or other anatomical or functional issues affecting gastric emptying.
The physician performs the procedure under fluoroscopic guidance, including prepping and anesthetizing the patient, inserting guidewires and catheters, injecting contrast, confirming proper tube placement, securing the tube, and applying dressings.
In simple words: A doctor uses X-ray imaging to guide the replacement of a feeding tube in your stomach (G-tube) with a feeding tube that goes into your small intestine (GJ-tube).This is done through a small opening in your skin, without a major surgery.
This procedure involves converting an existing gastrostomy tube (G-tube) to a gastrojejunostomy tube (GJ-tube) percutaneously under fluoroscopic guidance. It includes contrast injection(s) for visualization and confirmation of correct placement, image documentation, and a report.The existing G-tube is exchanged for a GJ-tube, which extends into the jejunum, allowing for feeding directly into the small intestine. This is often necessary for patients who cannot tolerate gastric feeding due to conditions such as gastroparesis or severe reflux.
Example 1: A patient with gastroparesis experiences recurrent vomiting despite medication. The existing G-tube is converted to a GJ-tube to allow feeding directly into the jejunum., A patient with severe GERD and a history of aspiration pneumonia requires a GJ-tube placement to bypass the stomach and reduce aspiration risk., A patient with a non-healing stomach ulcer requires long-term enteral nutrition. Conversion of the G-tube to a GJ-tube provides access for feeding while the ulcer heals.
Documentation should include the reason for the conversion, the procedure details (including fluoroscopic guidance and contrast administration), confirmation of placement, and any complications. Pre- and post-procedure images should also be included.
- Revenue Code: P6C - MINOR PROCEDURES - OTHER (MEDICARE FEE SCHEDULE)
- Specialties:Gastroenterology, Interventional Radiology, General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center