# Unsure of correct CPT for PEG tube and cosurgeons



## coder25 (Jun 17, 2010)

Good morning!

I am unsure if the codes that I have for the following procedures are correct and would appreciate any input. 

PROCEDURE:  Lap-assisted percutaneous endoscopic gastrostomy tube placement and EGD.

SURGEONS:  Dr. A. 

CO-SURGEON:  Dr. B.

In the supine position, the abdomen was prepped and draped in the usual sterile fashion.  An EGD was performed by Dr. B. secondary to lack of availability of a qualified resident (we work for a teaching hospital).  The mucosa of the esophagus, GE junction, stomach and proximal duodenum were all WNL.  Some slight NG tube erosions were noted in th stomach.  The stomach was then insuffluated and there was good transillumination on the anterior abdominal wall. 

Next, and approximately 3.0 cm incision was made above the umbilicus.  The abdomen was then entered using an open technique and a 5 mm port was placed through the fascial opening and the anterior abdominal wall was visualized.  Next, an approximately 1.0 cm transverse incision was made lateral to the pacemaker leads. A standard 20-gauge finder needle was used to access the stomach through the anterior abdominal wall.  This was directly visualized with the EGD and laparoscope.  The needle was then retracted and a standard guidewire was inserted through the needle into the stomach and directly visualized with the EGD.  A loop snare was then passed down through the EGD which snared the catheter which was followed by the wire.  The needle was then removed from the anterior abdominal wall and entire apparatus, including the snare and wire, was removed in a retrograde fashions via esophagus and through the anterior abdominal wall.  The pedicle was placed to approximately 3.0 cm.  The wire was cut and the flanage was used to anchor the PEG to the skin surface.  The PEG tube was placed to gravity drainage and and abdominal binder was placed.  

The patient tolerated the procedure well.  Dr. A. was present and scrubbed for the case.  (OP note dicted by resident)

I know that the PEG tube code would be 43246. However, would I bill for a diagnostic laparoscopy along with the PEG?  If so, would it be 49320?

I spoke with Dr. B who stated that he visualized the upper portion of the stomach, while Dr. A. placed the PEG tube.  How would I bill this out for these two surgeons? (They both work for my practice).  

Would I just bill 43246-82 or would I only given 43246 to the primary surgeon, Dr. A?

Thanks for the help.


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## jcoil (Jun 18, 2010)

I would use 43246-62.  Jodie


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## Jan (Jun 21, 2010)

I agree, that is what I use when coding for the procedure by two separate surgeons.


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