Gastroenterology Coding Alert

Bonus: Be the first to know how to use the 2 new fecal occult test codes If you've pegged 2008 for being the year that will transform the way you report PEG tube services, you were right. Most of the CPT 2008 gastroenterology changes involve revised and new gastrostomy tube codes, and you've got little time to digest this information -- the new codes go into effect Jan 1. Good advice: "It's a good idea to make a cheat sheet for your physicians," says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta. "Along with telling your physicians about the changes, having this information on their chart area is usually much easier for them to remember." Continue Coding 43246 for True PEG Claims Although CPT added nine new codes for insertion and other procedures involving gastrostomy and other tubes, you don't have to change how you normally report percutaneous endoscopic gastrostomy (PEG) tube placements. If your gastroenterologist places a true PEG tube, your code of choice is 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) -- for now and into the next year. CPT 2008 makes no changes to this code. What to look for: The op note for 43246 will describe an upper GI endoscopy with insertion of the gastrostomy tube. As the code descriptor specifies, placement of this type involves both an endoscopic and a percutaneous (through-the-skin) component. Generally, the purpose of the tube is either to provide nutrition (a feeding tube) or to act as a drain (in place of a nasogastric tube). Implement These G-Tube Replacement Changes First, you should take note of this clarification on G-tube replacement code 43760 (Change of gastrostomy tube). CPT 2008 adds "percutaneous, without imaging or endoscopic guidance" to the code's descriptor. The language makes the code's appropriate use more clear, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program. "My take on the new codes available for G-tube replacement is the following: • You'll use 43760 for G-tube change with no radiologic supervision. • You'll use 43760 with the newly revised code 75984-26 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation; professional component) when the physician changes the G-tube with contrast. • You'll use code 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) when your physician changes (replaces) the tube under fluoroscopic guidance," [...]