Gastroenterology Coding Alert

Replacing, removing, or inserting: Get the scoop on coding these services.

GI patients often require gastrostomy tubes, which can deliver vital nutrients to those who have issues swallowing or ingesting foods and beverages. However, coding for G-tube services can get tricky, since there are nuances to the insertion, removal, and replacement of these devices that can lead to different codes or added modifiers.

Read on for three of the most frequently-asked G-tube questions, along with answers that can guide your coding.

Question 1: Our physician removed a flange of worn-out G-tube before introducing a MIC tube and anchoring it with a balloon via gastroscope. Should we report 43247 for the removal? And then how do we report the insertion?

Answer:  You should not report 43247 (Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body[s]) for this scenario, because the flange removal is included in the insertion of the new tube.

Therefore, the only code you should report for this situation is 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube).

Question 2: A patient presented to the hospital from a nursing home, where he had dislodged his G-tube. The gastroenterologist placed a new G-tube into the established percutaneous tract, then aspirated gastric contents, confirming that the tube was safely in the stomach. Which codes apply to these services (the G-tube replacement and the gastric contents removal)? We are leaning toward 49460 for the latter service but not sure about the former.

Answer: In this situation, your best bet is to report 43762 (Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract) for this service, since the physician percutaneously replaced the tube and did not revise the gastrostomy tract.

You should not report 49460 (Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed, image documentation and report) for the physician’s work aspirating the gastric contents because he performed that service as part of the new G-tube placement, and the pay for that is therefore included in 43762.

Question 3: Our GI physician removed a PEG tube for a patient in the office and did not replace it. We cannot find a code for this. Should we use 43762?

Answer: No. In this situation, you cannot report 43762 – this code only applies if the gastroenterologist removed the PEG tube then placed another one.

Instead, your best bet for a PEG tube removal in the office is to report the appropriate outpatient E/M code (99201-99215), which you should select based on the physician’s documentation.