ED Coding and Reimbursement Alert

Question: A patient reported for replacement of a jejunostomy tube (J tube). I-ve never coded for this procedure before, and I am stumped. I cannot find an exact CPT code for J tube replacement, so how can I report this service?


Michigan Subscriber


Answer: While ED physicians more frequently replace gastrostomy tubes (G tubes), patients requiring jejunostomy tube (J tube) replacement can also present to the ED for treatment. There is no specific CPT code to perfectly describe J tube replacement, although CPT is looking at this issue for 2008.
 

Some coders might choose 43760 (Change of gastrostomy tube) for the service, since it sounds close enough to a J tube replacement. But even though J tube replacements and G tube replacements may be similar, they aren't the same. So you should not rely on 43760 for this encounter.
 
Best bet: Instead, you should select an appropriate unlisted-procedure code. Report 43999 (Unlisted procedure, stomach) for the encounter. And to give your claim the best chance of acceptance, don't skimp on the documentation. Include notes that compare the J tube replacement to a similar procedure with a dedicated code. So when you submit 43999 for the J tube change, you might include notes to this effect:
 
-The procedure was similar in complexity, and required similar resources, to that described by gastrostomy tube change code 43760.-
 
With notes describing the expertise and effort the ED physician expended during the J tube replacement, the payer will be able to make an informed decision on the pay rate for your unlisted-procedure claim.