ED Coding and Reimbursement Alert

Question: A patient presents in the emergency department (ED) with rectal bleeding. The ED doctor performs "gastric aspiration," noting no blood in the contents. The physician also notes the "frequent flier" status of this patient, and suspects drug-seeking behavior. How should I report this case?
    
Illinois Subscriber
 
Answer: You can describe this procedure with code 91105 (Gastric intubation, and aspiration or lavage for treatment [e.g., for ingested poisons]), if the physician performed this service, and make sure you have a procedure note before doing so. Previously, you could have reported it using 43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation, and report]), but now the physician must perform fluoroscopic guidance to use this code.
 
ED staff frequently carry out gastric lavage procedures to find out whether a patient has active bleeding from the stomach. The tube may be placed orally or nasally - in a case like this, it would probably be inserted through the nose. Make sure there is proper documentation and a procedure note to reflect the medical necessity for the physician's involvement.