ED Coding and Reimbursement Alert

Question: A hospice patient presents to the ED with a malfunctioning gastrostomy tube (G tube). The tube was installed two weeks earlier, and seems to have just "popped" out of place. The ED physician puts the tube back in place and ensures that it is in the proper position using contrast monitoring. Is this part of the G tube placement code, or can I code the monitoring separately?

Minnesota Subscriber

Answer: When the physician needs to use contrast monitoring while replacing a G tube, it is separately reportable. On the claim, report the following:

- 43760 (Change of gastrostomy tube ...) for the tube replacement

- 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation) for the contrast monitoring

- modifier 26 (Professional component) appended to 75984 to show that you are only coding for your physician's role in the monitoring

- 536.42 (Mechanical complication of gastrostomy) appended to 43760 and 75984 to represent the malfunction.