Virginia Posted Thu 02nd of July, 2020 13:00:22 PM
We've been receiving push back on use of the unlisted codes 43999 or 44799 when GJ or J tubes are replaced and flouroscopic guidance is not used. There have been new codes for G tube replacements with out image 43762 and 43763, but no new codes have been released for GJ or J tubes. We have research material that we've submit for the use of these unlisted code (CPT Assist March 2010 page 10, AGA: Are you coding G-J tube placements correctly Oct 24, 2012, Supercoder: Document to support Pre-existent placement of J tubes July 2013) and have been unsuccessful getting the unlisted codes approved since the release of 43762 and 43763. The response we've been getting is the material provided is out dated. We've struggled to find any recent release for use to the unlisted codes. The only other thing is to possibly use codes 49451 or 49452 with modifier 52, but the procedure is completed just without flouroscopic guidance. We wouldn't be comfortable using mod 52. Any help would be appreciate for any current information you can provide to support the use of the unlisted code.
SuperCoder Answered Fri 03rd of July, 2020 05:20:56 AM
Yes, CPT 43762 and 43763 have been released for the G tube replacement without imaging guidance and when it is performed under fluoroscopic guidance CPT 49451 and 49452 are used for J tube and G-J tube respectively. Since, the codes for J and G-J replacement are available, then as per the guidelines, unlisted codes cannot not be used. So, the best way to bill the services by appending modifier 52 (Reduced Services) with the codes 49451 and 49452. Providing unlisted codes for these services would be inappropriate. Although, there is no such released of CPT Assistant related to the unlisted codes in this regard. However, there is release of CPT assistant for CPT 43999, but related to other situations. You can refer "July 2018; Volume 28: Issue 7" and "December 2018; Volume 28: Issue 12" for your kind reference.
Hope this helps!