# Removal of Peg (Not the surgeon that placed it)



## gniedermaier (Dec 14, 2011)

How would you bill for the removal of a peg tube if you are not the surgeon that originally placed it?  43235 with V55.1 or 43247 with 936?  All replies appreciated.  Thank You

Gina N, CMC


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## Lujanwj (Dec 14, 2011)

Depends on the work done and where. If done in the OR, 43870.  If done in the office and dr just slide it out, part of E/M.   If done in the office and dr had to do a lot of work, 43870 (depending on carrier) or 43999 for CMS.  CMS has a place of service issue with 43870.  They want it done in the OR.  V55.1 should be fine.


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## amandahollis80 (Dec 14, 2011)

By the term PEG (percutaneous endoscopic gastrostomy) tube, are you referring to a gastrostomy tube? If so, the only code you can charge for a removal is an E&M. There is no CPT code for just the removal of a G-Tube.


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## gniedermaier (Dec 15, 2011)

I am still unsure about this.  A part of me agrees with both responses but it does not seem approriate to bill for an E&M code when you are performing an operative procedure.  You are removing a peg that was not originally placed by you or anyone in your group.  For any other type of procedure that does not have a specific code, you would choose an unlisted procedure code.  I would appreciate any additional feedback since again, I am struggling with this.  I am going to contact Medicare to find out if they can provide any addtional information.  Thank You again for responding.

Gina Niedermaier, CMC


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## DLS5697 (Dec 19, 2011)

E & M code, doesn't matter if you doc didn't put it in, takes them a minute to pull a gastrostomy and they only take them to the OR if the site doesn't close on it's own, oh and your over thinking


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## Lujanwj (Dec 19, 2011)

If Dr is taking a patient to the OR they are no long doing an E/M, Dr is doing a procedure which dr should be properly reimbursed for.  

Percutaneous endoscopic gastrostomy.  Now you have a gastrostomy whether theres a tube there or not.  If dr returns to the OR to repair the gastrostomy, I'd recommend you use code 43870 - Closure of a gastrostomy, surgical - That is what the code is for since Dr went to OR and surgically closed the gastrostomy.  Code is specific to surgical so not to be confused with an E/M.


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## FTessaBartels (Dec 19, 2011)

*Please post the op note*

*For an accurate response to surgical coding questions, please post the scrubbed operative / procedure note.*

Hope that helps.

F Tessa Bartels, CPC, CEMC


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