# G Tube replacement



## kyannekis

What ICD 9 Codes are used when a patient pulls out the G Tube and you do the replacement?  Is this considered a mechanical complication or just the V55.1 code?


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## mkj2486

I have always used the v55.1.  A mechanical complication would be if the G tube itself has a problem. In this case the patient is the problem.


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## vj_tiwari

Hey,

I think 536.42 plus V55.1.

As per *mkj2486*, "A mechanical complication would be if the G tube itself has a problem. In this case the patient is the problem". But even patient pull the G tube or the G tube is fell out (or as per the given info.) the G tube have complications & so replaced. Hence I coded as above.

Hope this helps! 

VJ.


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## suemt

I found this information:

EX 3: PATIENT PRESENTS TO ED BECAUSE THEY PULLED OUT THEIR G-TUBE AND SAME TUBE IS REINSERTED IN THE ED. DX: REPLACE G-TUBE

Answer: Assign code V55.1, Attention to gastrostomy, as the principal
diagnosis. There are no complications with the gastrostomy, therefore, no
complication code is appropriate for this case.

Here is the reference:  http://www.cditalk.com/content/223-Gastrostomy-Complications


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## suemt

*What CPT code to use?*

when the patient pulls out the tube and it is just reinserted (not surgically)?  

49450 and 43760 don't seem to fit. 

This is the question I was searching for when I happened upon this thread.


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## sheardmd

We have always used 43760 and 536.49.


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## bridgettemartin

Like Melissa, we use 43760, with 536.49 when a patient pulls out their PEG, and it is manually replaced without the use of a scope.


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## mitchellde

Just to replace the G tube is not a complication!  If the reason for the encounter is just to remove and/or replace the G tube the correct code is the V55.1.  A coder cannot diagnose a complication when the provider has not indicated that one exists.


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## suemt

Hi, Debra.  Thanks for weighing in on this.  I value your opinion, and agree with you on the V55.1 Dx.  

My question is the CPT, and I'm thinking by the description that it would be considered part of the E/M visit.  

This was not even the specific reason for the visit, it was part of a regular home visit, and the provider just had one fraction of a sentence in the note "reinserted PEG".  I'm having a hard time justifying coding the 43760 with a $400 reimbursement for what sounds like the provider just popped a tube into a port.  Also, the description says "change" gastronomy tube, not reinsert the one that the patient pulled out.


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## acf7575

2008 CPT Assistant Answers this question.

Year: 2008 

Issue: April 

Pages: -11 

Title: Coding Consultation: Questions and Answers 

Body: Surgery: Digestive System

Question: A patient presented with a clogged gastrostomy tube. After examining the existing tube site, the physician deflated the balloon. The existing gastrostomy tube was removed. A new balloon tube was tested and inserted without the use of fluoroscopic guidance. What is the appropriate code to report for this procedure?

Answer: The appropriate code to report for this procedure is code 43760, Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance.


My question is a clogged tube a complication of the original placement?  We have a scenario where the patient had one placed in an open fashion, comes to the office with a clogged catheter and the provider replaces it.  If this is a complication, I cannot use modifier 78 for the office replacement (place of service 11), so does a replacement then become routine post operative care and not separately billable or is modifier 79 applicable?

Does a clogged gastrostomy tube fall into the services included in the global surgery payment as per Medicare?
  All additional medical or surgical services
  required of the surgeon during the post-operative
  period of the surgery because of complications,
  which do not require additional trips to the
  operating room;
Or is it
  Clearly distinct surgical procedures that occur
  during the post-operative period which are not reoperations
  or treatment for complications;


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## bruxy83@gmail.com

I have one today where the provider is changing the GTube from a long form to a low profile for the first time. Which ICD-9 would you use for this? Its not a complication and the V44.1 my provider chose isnt considered a primary dx code.


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## AnnesPics

*Change Gtube @ home*

_ I have the same problem with the CPT 43760 being denied by HZN for a home visit.  My Dr. was specifically called to the home for this reason.  What other CPT or is there a modifier that I can use to get this covered?  Any help would be greatly appreciated.  
Thank you in advance!
_


suemt said:


> Hi, Debra.  Thanks for weighing in on this.  I value your opinion, and agree with you on the V55.1 Dx.
> 
> My question is the CPT, and I'm thinking by the description that it would be considered part of the E/M visit.
> 
> This was not even the specific reason for the visit, it was part of a regular home visit, and the provider just had one fraction of a sentence in the note "reinserted PEG".  I'm having a hard time justifying coding the 43760 with a $400 reimbursement for what sounds like the provider just popped a tube into a port.  Also, the description says "change" gastronomy tube, not reinsert the one that the patient pulled out.


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