CPT® Code 43246

The procedure described by CPT® Code 43246 is known as esophagogastroduodenoscopy (EGD) with directed placement of a percutaneous gastrostomy tube (PEG). This procedure is particularly indicated for patients who are unable to ingest food or liquids orally for an extended duration, often due to various medical conditions affecting swallowing or gastrointestinal function. The process begins with the administration of a local anesthetic spray to numb the mouth and throat, facilitating the insertion of a flexible fiberoptic endoscope. This endoscope is a thin, flexible tube equipped with a camera and light source, allowing for direct visualization of the esophagus, stomach, and duodenum. During the procedure, the endoscope is carefully advanced through the mouth and into the esophagus, where the physician inspects for any abnormalities. The endoscope is then further advanced into the stomach, which is inflated with air to enhance visibility. The various regions of the stomach, including the cardia, fundus, greater and lesser curvature, and antrum, are thoroughly examined. Following this, the endoscope is passed through the pylorus into the duodenum and/or jejunum for additional inspection of the mucosal surfaces. Once the endoscopic examination is complete, the PEG procedure is initiated. This involves making a small incision in the skin and upper abdominal wall, typically on the left side. A guidewire is then inserted through this incision and advanced into the gastric cavity under direct endoscopic visualization. A feeding tube is subsequently placed over the guidewire and into the stomach, after which the guidewire is removed. The feeding tube is then advanced through the stomach wall and secured in place, allowing for nutritional support to be provided directly to the stomach. This procedure is essential for patients requiring long-term enteral feeding, ensuring they receive adequate nutrition despite their inability to eat orally.