CPT® Code 0647T

Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report

The procedure described by CPT® Code 0647T involves the insertion of a gastrostomy tube using a percutaneous approach, specifically employing magnetic gastropexy under ultrasound guidance. This innovative technique, known as percutaneous ultrasound gastrostomy (PUG), is designed to facilitate the placement of a gastrostomy tube at the bedside without the need for fluoroscopy or endoscopy. The procedure utilizes a specialized device called the point-of-care ultrasound magnetically aligned gastrostomy (PUMA-G) device, which includes an orogastric catheter equipped with a balloon tip that contains a magnetic bar. An external hand-held magnet is also utilized during the procedure. The process begins with the insertion of the orogastric tube through the mouth or nose into the stomach. The external magnet is then positioned over the balloon's location within the stomach, allowing the physician to maneuver the balloon to the desired site while simultaneously using ultrasound imaging for guidance. The magnets generate a static compressive force that effectively pushes the stomach against the abdominal wall, facilitating the creation of a clear pathway for the gastrostomy tube. Ultrasound imaging is employed once more to visualize the intended gastrostomy tract, which extends from the skin to the stomach. Following this, a cutaneous puncture is made, and a guidewire is inserted through the puncture site into the stomach. Finally, the gastrostomy tube is carefully placed over the guidewire, ensuring it is positioned correctly within the stomach. This procedure is particularly beneficial for patients requiring long-term nutritional support, as it allows for a minimally invasive approach to gastrostomy tube placement.