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2025 CPT code 49451

Replacement of a duodenostomy or jejunostomy tube percutaneously, using fluoroscopic guidance, including contrast injections, image documentation, and a report.

Adhere to the official CPT coding guidelines and any payer-specific instructions when reporting this code.Documentation must accurately reflect the procedure performed.

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.

IMPORTANT:If the procedure is performed without fluoroscopic guidance, an unlisted procedure code (e.g., 44799) with modifier 52 (reduced services) might be considered.However, documentation must clearly justify the use of an unlisted code.

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.

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