Nasogastric Tube Placement
43752
[Bowel obstruction / gastric decompression / ileus / enteral feeding access / medication administration / upper GI bleeding monitoring]
Same
Nasogastric tube placement, [right / left] naris
[Attending name], MD/DO
[Nurse/tech name]
None / [topical lidocaine spray to posterior pharynx]
The patient is a [age]-year-old [male/female] with [indication: bowel obstruction / ileus / need for enteral access / upper GI bleed monitoring] requiring nasogastric tube placement for [gastric decompression / enteral feeding / medication administration]. The risks, benefits, and alternatives were explained to the patient.
A [14 Fr / 16 Fr / 18 Fr] nasogastric tube was advanced through the [right / left] naris and into the stomach. Correct gastric positioning was confirmed by [chest radiograph / auscultation of air insufflation over the epigastrium / aspiration of gastric contents with pH ≤5]. Immediately upon connection to wall suction, [X] mL of [bilious / blood-tinged / dark green / clear] gastric contents were obtained.
The patient was positioned with the head of the bed at 30–45 degrees. The patency of the [right / left] naris was confirmed. The NEX measurement (Nose-Earlobe-Xiphoid) was calculated to estimate the appropriate insertion length.
The posterior nasopharynx was anesthetized with [topical lidocaine spray]. A [14 Fr / 16 Fr / 18 Fr] nasogastric tube was lubricated with water-soluble lubricant. The tube was inserted through the [right] naris and advanced along the floor of the nasal cavity posteriorly. The patient was asked to swallow repeatedly [or sipped water through a straw] as the tube was advanced into the esophagus and then stomach. The tube was advanced to approximately [55–60] cm at the nostril.
Gastric positioning was confirmed by [chest radiograph showing the tube tip below the diaphragm in the gastric body / auscultation of air bolus over the epigastrium / aspiration of gastric contents with pH testing]. The tube was secured to the nose with tape. Upon connection to [intermittent low wall suction / gravity drainage], [X] mL of [bilious / gastric] contents was obtained.
None
None / [Gastric aspirate sent for pH / other]
None
[14 Fr / 16 Fr / 18 Fr] NGT in [right / left] naris, [X] mL output upon placement, connected to [low intermittent wall suction / gravity drainage]
The patient tolerated the procedure without significant discomfort. The tube was functioning appropriately. Correct position was confirmed prior to use.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Nasogastric tube placement, *** naris
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: Topical: ***
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX requiring NGT placement for ***. Risks and benefits explained.
FINDINGS: *** Fr NGT placed via *** naris to *** cm. Position confirmed by ***. *** mL *** contents obtained on connection to suction.
PROCEDURE:
Patient at 30–45 degrees. *** naris patency confirmed. NEX measurement calculated. Posterior pharynx anesthetized with ***. *** Fr NGT lubricated and advanced along nasal floor. Patient swallowed as tube advanced to *** cm at nostril. Position confirmed by ***. Tube secured with tape. Connected to *** suction. *** mL *** output.
COMPLICATIONS: None
DRAINS: *** Fr NGT, *** mL output
DISPOSITION: Tube functioning, position confirmed prior to use.
Signed: .ME, .MYDEGREE
.TODAYVariants
Difficult Placement: Stylet / Ice Water Technique
Initial placement was unsuccessful due to [coiling in the posterior pharynx / patient agitation / altered anatomy]. The tube was stiffened by [placement in ice water for 5 minutes / use of the internal stylet] and reattempted with the head in a more flexed position. Successful placement was confirmed on the second attempt. Stylet was removed prior to securing the tube. Position confirmed by CXR before use.
Post-Pyloric Feeding Tube (Dobhoff)
A [10 Fr] Dobhoff tube with stylet was placed for post-pyloric enteral feeding given [aspiration risk / gastroparesis / pancreatitis]. The tube was advanced to 90 cm. Position was confirmed by [abdominal radiograph showing the weighted tip beyond the pylorus in the duodenum / fluoroscopy]. The stylet was removed only after radiographic confirmation of position. The tube was secured and marked at the naris.
Charting Tips
- Always document the method of position confirmation before the tube is used — CXR is the gold standard. Auscultation alone is insufficient and has been associated with inadvertent pulmonary placement. Document CXR result explicitly.
- For Dobhoff or feeding tubes with stylets, document that the stylet was removed only after radiographic confirmation of correct position — stylet-related small bowel perforations are a known complication of premature stylet removal.
- Document tube size (Fr), naris used, insertion depth at the naris, and initial output character and volume. This establishes the baseline for nursing to detect tube migration.
Billing Tips
- Bill 43752 for nasogastric or orogastric tube placement requiring physician skill (0.79 wRVU, 0-day global). In most inpatient settings, NGT placement by nursing is not separately billable by the physician. This code applies when a physician places the tube due to clinical complexity.
- Physician billing for 43752 requires documentation of medical necessity for physician involvement: e.g., altered anatomy, failed nursing placement, or high aspiration risk requiring direct physician supervision.
- 0-day global: no bundled postoperative period. If placed as part of a separate operative procedure, it is typically bundled and not separately billed.
- Fluoroscopic guidance during NGT placement (e.g., for small bowel access) can be billed separately with 76000. Document the need for guidance and confirm the image record is saved.
- For long-term enteral access, PEG tube (43246, 3.47 wRVU) or surgical jejunostomy (44015) are the appropriate codes. NGT placement is not billable as a feeding tube procedure.