CPT® Code 49442

Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

The CPT® Code 49442 refers to the procedure of inserting a cecostomy or other colonic tube through a percutaneous approach, utilizing fluoroscopic guidance. This procedure is particularly relevant for patients experiencing fecal incontinence, as it allows for the direct access to the colon for therapeutic interventions. Prior to the insertion, a bowel preparation is essential, which typically involves a regimen of clear liquids for one to two days, along with an oral laxative administered the evening before the procedure. This preparation ensures that the colon is adequately distended, facilitating the insertion process. During the procedure, the patient is positioned appropriately, and local anesthesia is applied to minimize discomfort. The colon is inflated with air to achieve the necessary distension, and under continuous fluoroscopic guidance, a needle is carefully inserted into the cecum or another segment of the colon. The procedure includes securing the bowel to the abdominal wall with fasteners, followed by the introduction of a guidewire and dilation of the tract. A sheath is then placed, allowing for the insertion of the colonic tube through the abdominal wall into the designated area of the colon. After the tube is positioned, it is flushed with normal saline and capped for use. The patient is instructed to utilize this tube for administering phosphate and saline enemas, which aid in bowel evacuation and help manage fecal incontinence. Throughout the procedure, radiographic imaging is continuously employed, including the use of contrast injections, to ensure accurate placement and verification of the tube's position, culminating in comprehensive image documentation and a written report as part of the procedure's requirements.