# PEG tube placement - Does anyone have any information



## TWinsor (Feb 27, 2008)

Does anyone have any information regarding placement of the PEG tube, specifically when the physician does not go into the duodenum/jejunum?  We are discussing whether to use the -52 modifier if they physician only goes to the stomach. 

If anyone knows of something in writing please let me know. 

TIA


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## hpierce (Mar 20, 2012)

*RE: PEG Tube Placement*

Hi, did you ever get an answer on this? I asked the same question.

Thanks!
Heather, CPC


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## colorectal surgeon (Mar 22, 2012)

First of all, 43246 states with examination of duodenum and/or jejunum as appropriate.

Second, the intended extent of the procedure is the stomach, so I don't think you need the -52 modifier.  

Any GI coders have an opinion?


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## FTessaBartels (Mar 30, 2012)

*AND duodenum*

43246  
Upper gastrointestinal endoscopy including esophagus, stomach, *and* either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube  


Our compliance department is stuck on the word "and" (as I've highlighted above).  Their position is that to complete the procedure you must examine esophagus, stomach and duodenum and/or jejunum.  So if they stop in the stomach we add a -52 modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## Torilinne (Apr 3, 2012)

I'm not sure I agree that the "and" is the questionable word in this code descriptor.  I think the "as appropriate" is more questionable.  In all the lay term descriptions I've looked at for code 43246 the provider is described as only going into the stomach and there is no reference to either the duodenum or the jejunum.  I bet you could argue the heck out of this one!  

V Davis CPC, CGIC


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## colorectal surgeon (Apr 3, 2012)

I would have to agree with the as appropriate part!


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