# Egd with removal of peg



## rsboggs (Nov 1, 2010)

Our surgeon often does an EGD with placement of PEG tube, but this is the first EGD we have done with removal of a PEG. We typically do this under local at the bedside or in the office. This patient was non-mobile, obese and the tube had been in a long time. He was unable to safely remove the tube in the office so he took her to endoscopy. 

My question is could this be coded as 43247 EGD with removal of foreign body?

Thanks!


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## JenReyn99 (Nov 3, 2010)

I was curious about this too, this is what I found

 NCCI edits state:

"Intubation of the GI tract (e.g. percutaneous placement of g-tube) includes subsequent removal of the tube. CPT codes such as 43247 should not be reported for routine removal of previously placed therapeutic devices."


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## JenReyn99 (Nov 3, 2010)

I was curious about this too, this is what I found

 NCCI edits state:

"Intubation of the GI tract (e.g. percutaneous placement of g-tube) includes subsequent removal of the tube. CPT codes such as 43247 should not be reported for routine removal of previously placed therapeutic devices."


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## eescalante (Nov 3, 2010)

Removal of the peg tube during an EGD (when the peg is removed endoscopically and pulled up through the esophagus) can be billed as an EGD with foreign body removal. 

If the PEG is removed in the typical manner then the NCCI edit quoted above is correctly applied - the PEG removal isn't coded. In this case the encounter to remove the PEG tube can be coded an appropriate E&M code as long as the other requirements for the E&M service are met.


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## rsboggs (Nov 11, 2010)

Thank you both!


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## Berd21 (Nov 11, 2010)

Couldn't you use 49460 manual removal of colonic tubes including G-tubes, j-tubes and other colonic tubes?


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## JenReyn99 (Nov 11, 2010)

49460 would not be appropriate, the extended description says this: The physician mechanically removes obstructive material from an existing tube (gastrostomy, duodenostomy, jejunostomy, gastrojenjunostomy, or cecostomy) by and method. 

That code is for actually removing an obstruction from the tube, not removal of the tube itself.


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## rachell1976 (Nov 19, 2010)

We had an MD that removed PEG tube @ sugery due to unsuccessful and painful attempts in the office.

They gave PT light sedation with versed, and were able to deflate the balloon and remove the PEG tube without incident. 

The plan had been to do an endoscopic removal, but the tube came out with the first try non-endoscopically.

We are wondering if we should bill unlisted? Service was at the hospital in same day surgery, so not able to bill an E/M and no other service was provided to bundle it with.

suggestions?


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## KRED (Nov 28, 2010)

I had a similar case where the peg tube was removed at the ssu.  I was wondering if an e/m code could be billed since it was outpatient?


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