CPT® Code 43756

1. Indications

The procedure described by CPT® Code 43756 is indicated for the following conditions:

• Evaluation of Duodenal Contents The procedure is performed to analyze the contents of the duodenum, which may include assessing for the presence of crystals or other abnormalities.
• Bile Study It is specifically indicated for conducting a bile study to investigate the presence of crystals in the bile, which can be crucial for diagnosing certain gastrointestinal disorders.
• Afferent Loop Culture The procedure may also be indicated for obtaining a culture from the afferent loop, which can help in identifying infections or other pathological conditions.

2. Procedure

The procedure for CPT® Code 43756 involves several key steps that ensure the successful intubation and aspiration of the duodenum:

• Step 1: Preparation The patient is prepared for the procedure, which includes an assessment of the nostrils to determine the more patent one for tube insertion. This step is crucial for ensuring a smooth and effective intubation process.
• Step 2: Anesthesia Application Viscous lidocaine is instilled into the selected nostril to provide local anesthesia, minimizing discomfort during the tube insertion. This step is essential for patient comfort and cooperation throughout the procedure.
• Step 3: Tube Measurement The length of the gastric tube required for insertion into the duodenum is estimated and marked. This measurement is important to ensure that the tube reaches the appropriate anatomical location without causing injury.
• Step 4: Tube Insertion The tube is inserted into the nostril and advanced through the nasopharynx. The patient may be instructed to sip water to facilitate the advancement of the tube through the oropharynx, esophagus, and into the stomach, and finally into the duodenum. This step requires careful technique to ensure proper placement.
• Step 5: Image Guidance Throughout the procedure, image guidance is utilized to confirm that the tube is successfully advanced into the duodenum. This step is critical for ensuring accurate placement and minimizing complications.
• Step 6: Specimen Collection Once the tube is correctly positioned in the duodenum, one or more specimens are obtained for analysis. In the case of CPT® Code 43756, a single specimen of duodenal content is collected, which is essential for diagnostic purposes.

3. Post-Procedure

After the completion of the duodenal intubation and aspiration procedure, the patient may be monitored for any immediate complications or discomfort. It is important to assess the patient for any signs of adverse reactions to the local anesthesia or the procedure itself. The collected specimen will be sent for analysis, and the results will be used to guide further diagnostic or therapeutic interventions as necessary. Patients may be advised on any specific post-procedure care, including dietary restrictions or follow-up appointments, depending on the findings and clinical context.