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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.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 49442 is indicated for patients experiencing fecal incontinence. This condition may arise from various underlying issues, including neurological disorders, structural abnormalities, or other gastrointestinal dysfunctions that impair the normal control of bowel movements. The insertion of a cecostomy or colonic tube provides a means to manage these symptoms effectively, allowing for the administration of enemas that facilitate bowel evacuation and improve the patient's quality of life.
The procedure begins with a thorough bowel preparation, which is crucial for ensuring optimal conditions for the insertion of the cecostomy or colonic tube. This preparation typically involves the patient consuming only clear liquids for one to two days prior to the procedure, along with the administration of an oral laxative the evening before. This regimen helps to clear the bowel and allows for adequate distension during the procedure.
After the procedure, patients are typically monitored for any immediate complications or discomfort. They may be provided with specific instructions regarding the care and maintenance of the cecostomy or colonic tube, including how to properly administer enemas. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to make any necessary adjustments to the management plan. Patients should be educated on signs of potential complications, such as infection or tube dislodgement, and advised to seek medical attention if they experience any concerning symptoms.
| Short Descr | PLACE CECOSTOMY TUBE PERC | Medium Descr | INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS | Long Descr | Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 73 - Ileostomy and other enterostomy |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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