CPT® Code 49446

Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

The procedure described by CPT® Code 49446 involves the conversion of a gastrostomy tube to a gastrojejunostomy tube using a percutaneous technique, which is performed under fluoroscopic guidance. A gastrostomy tube is a medical device inserted through the abdominal wall into the stomach, allowing for nutritional support in patients who cannot eat by mouth. In this procedure, the existing gastrostomy tube is replaced with a gastrojejunostomy tube, which extends into the jejunum, the second part of the small intestine. This conversion is necessary for patients who may require long-term feeding and have specific gastrointestinal needs that necessitate bypassing the stomach. The procedure begins with the cleansing of the skin at the site of the gastrostomy tube, followed by the application of a topical anesthetic to minimize discomfort. Under fluoroscopic guidance, a stiff guidewire is inserted, allowing for the safe removal of the gastrostomy tube. The new gastrojejunostomy tube is then advanced over the guidewire, passing through the stomach and across the pylorus into the jejunum, specifically positioned just beyond the ligament of Treitz. Throughout the procedure, continuous radiographic imaging is utilized, including contrast injections, to ensure accurate placement of the tube and to verify its correct positioning within the gastrointestinal tract. The procedure concludes with the removal of the guidewire and securing the tube in place by inflating a balloon, ensuring that it remains properly positioned for effective use.