Reader Questions: Modifier 52 Makes the Case for Bolster Replacement

Question: How should I report replacement of a "mushroom basket" for a PEG tube? I can’t find a code for this in CPT.

Arkansas Subscriber

Answer: If your physician documents replacement of a "mushroom basket," report 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) appended with modifier 52 (Reduced services).

A mushroom-shaped basket, or bolster, holds the PEG tube in place on the inside of the stomach wall. Sometimes the physician will need to replace this device, which involves using endoscopy to go back into the stomach. Because this procedure essentially includes a "reduced" version of PEG tube placement, you are correct to describe it using 43246-52.

Tip: Be sure that you include documentation explaining the placement’s reduced nature with your claim.