2025 CPT code 49451
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Replacement of a duodenostomy or jejunostomy tube percutaneously, using fluoroscopic guidance, including contrast injections, image documentation, and a report.
Modifiers may be applicable depending on the circumstances of the procedure. For example, modifier 52 (reduced services) might be used if the procedure was significantly altered or if fluoroscopy was not used.Modifiers should be applied judiciously according to the official CPT guidelines.Always check for payer-specific rules on modifier use.
Medical necessity for a percutaneous replacement of a duodenostomy or jejunostomy tube is typically established by evidence of tube malfunction, dislodgement, or obstruction that compromises the patient's nutritional intake or ability to receive medications through the tube.
The clinical responsibility for this procedure rests with a physician qualified to perform gastrointestinal procedures and interpret fluoroscopic images, such as a gastroenterologist or surgeon.Proper preparation, anesthesia administration (if necessary), tube replacement, contrast injection, and post-procedural care are all part of the physician's responsibility.
- Surgery
- 49451 falls within the larger category of surgical procedures on the digestive system.It's specifically for the replacement of tubes in the duodenum or jejunum.
In simple words: The doctor replaces a tube already in place in the small intestine through a small hole in the skin.They use X-ray imaging to guide the process and make sure the new tube is correctly positioned.
This CPT code (49451) describes the percutaneous replacement of an existing duodenostomy or jejunostomy tube under fluoroscopic guidance.The procedure involves removing the old tube, inserting a new tube through the pre-existing percutaneous access site, and securing it. Contrast injection is used to verify proper tube placement, followed by image documentation and a report. The procedure is performed under fluoroscopic guidance to ensure accurate placement and minimize complications.
Example 1: A patient with a duodenostomy tube experiences a tube malfunction. The physician performs a percutaneous replacement under fluoroscopic guidance to restore feeding access. 49451 is reported., A patient's jejunostomy tube becomes dislodged. The physician replaces the tube percutaneously using fluoroscopy. 49451 is reported., A patient needs their jejunostomy tube replaced due to migration or blockage. The physician uses fluoroscopy for accurate placement of the new tube. 49451 is reported.
* Pre-procedure diagnostic imaging (if applicable) showing the need for tube replacement.* Operative report detailing the procedure, including the removal of the old tube, insertion of the new tube, contrast injection, image documentation, and verification of proper placement.* Post-procedure images confirming the position of the new tube.* Patient’s medical record showing need for the replacement
** This code should only be used when the replacement is done percutaneously through an existing tract, not for initial placement of a tube. The use of fluoroscopy is essential for accurate coding.
- Revenue Code: P6C (Minor Procedures - Other)
- RVU: The RVUs for this code will vary based on geographic location and other factors. Consult your local Medicare fee schedule or other payer's guidelines for precise RVU values and reimbursement rates.
- Global Days: The global period for this procedure is not explicitly defined in the provided data.It would likely be determined by local payer guidelines or medical practice norms.
- Payment Status: Active
- Modifier TC rule: This code does not appear to involve a technical component (TC) modifier since it is a complete procedure.
- Fee Schedule: Historical fee schedule data for this code can be found in publicly available resources like the CMS website, but may vary by year and location.
- Specialties:Gastroenterology, General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center