ED Coding and Reimbursement Alert

Question: The ED physician replaces a patient's malfunctioning gastrostomy tube (G tube). Due to the patient's excessive weight, the physician uses radiologic contrast monitoring to ensure the tube's proper placement (the patient's body mass index [BMI] is 28.4). Is the monitoring a separately reportable service? Mississippi Subscriber Answer: If the physician needs to use radiologic monitoring during G tube placement, you can report the service separately. On the claim, report the following: - 43760 (Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance) for the tube replacement - 536.42 (Mechanical complication of gastrostomy) attached to 43760 to represent the tube malfunction - 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation) to represent the monitoring. - modifier 26 (Professional component) linked to 75984 to show that you are coding only for the professional portion of the guidance - 536.42 attached to 75984 to represent the tube malfunction - 278.02 (Overweight) linked to 75984 to represent the patient's weight issues. -- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.