Question: In the past, we used 43750 for gastrostomy tube placement [note: CPT deleted 43750 for 2008]. Now, we must use 43246, but this code is not allowed with diagnostic endoscopy 43235. Is there any way that we can report the diagnostic endoscopy separately?
Texas Subscriber
Answer: No, you cannot unbundle the diagnostic endoscopy (43235, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]: APC 0141) from the percutaneous endoscopic gastrostomy (PEG) tube placement using endoscopy (43246, …with directed placement of percutaneous gastrostomy tube]: APC 0141).
Not only is 43235 a designated "separate procedure" -- and is therefore only reportable when it occurs in the absence of any related, more extensive procedure -- but CPT instructions clearly state, "surgical endoscopy always includes diagnostic endoscopy."
You may be able to report a diagnostic endoscopy if the surgeon replaces a gastrostomy tube percutaneously (43760, Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance: APC 0121) because of clogging or other factors. Be sure that the physician documents medical necessity for performing the endoscopy.
Note that if the physician does use the endoscope to place the feeding tube (rather than replacing the tube percutaneously), you should once again revert to 43246, according to CPT instructions. In this case, you would not report either 43760 or 43235.
