# Peg/PeJ Tube Placement



## SPECIALTYCODING (Sep 7, 2012)

Has anyone ever coded this procedure before?  Based on the documentation the Peg was placed endoscopically and the J-tube was snared by the endoscope.  I appreciate any suggestions or resources 

PROCEDURE IN DETAIL:  The patient was laid in the supine position.  The
gastroscope was inserted into the oropharynx and advanced down to the level
of the stomach without undue force. I then placed percutaneous endoscopic gastrostomy tube by identifying the appropriate part on the stomach with good transillumination.  An Angiocath sheath was passed through a transversely made incision in the abdominal wall
over the transilluminated area.  A wire was advanced down the sheath and
grasped with the scope, brought out through the oropharynx, and hooked to
the percutaneous endoscopic gastrostomy tube, it was pulled out through the
abdominal wall and trimmed down to approximately 9.5 cm.  A snare was
passed through the percutaneous endoscopic gastrostomy tube.  The scope was
passed through an open snare and then advanced down through the Roux limb.
I advanced an 0.35 Stiff Shaft Jagwire into the bowel, withdrew the scope,
opening the snare and then closing it over the wire.  I withdrew the scope
out of the oropharynx and then pulled the wire through the percutaneous
endoscopic gastrostomy tube with a small loop.  I figured out which end of
the wire was the oral end and pulled that out of the percutaneous
endoscopic gastrostomy tube and now had a wire going straight into the
percutaneous endoscopic gastrostomy tube and on into the Roux limb.  I
advanced an 8.5 French percutaneous endoscopic gastrojejunostomy tube over
the wire without undue force in good position.  Contrast proved it was well
positioned in the small bowel and the wire was withdrawn.  It was flushed
with saline and then clamped.


----------



## syllingk (Sep 7, 2012)

43246


----------



## syllingk (Sep 7, 2012)

with a -52


----------



## SPECIALTYCODING (Sep 12, 2012)

I don't understand why you would need a modifier 52, could you explain?

Thanks!


----------



## syllingk (Sep 13, 2012)

The note doesn's say that the scope went to the duodenum or jejunum as specified in the code so it would be a reduced service.


----------

