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 [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.