Ask Dr. Z

"Patient's previous PEG tube was removed due to fistula drainage. After gastric drainage, patient returned for new gastrostomy tube placement via the fistula. Patient was placed on the gastrostomy table, and fluoroscopy was used during the procedure. The skin around the G-tube site was prepped and draped. Using fluoroscopy, the track was recannulated, and a new 20 French gastrostomy tube was advanced into the stomach via the fistula access. A balloon was inflated, and contrast and air were injected through the tube to confirm final position. Tube was secure and bandaged." Would this be considered a new PEG tube with 49440 since fluoroscopy was used, or would this be 49450 just for the replacement of PEG tube since they aren't generating a new access?