Gastroenterology Coding Alert

You won't be in trouble reporting V codes as primary diagnosis.

When your office evaluates a patient for removal of percutaneous gastrostomy tube (PEG), you would typically code V55.1 (Attention to gastrostomy) to report the encounter. Physicians place PEG tubes into a patient's stomach to provide nutrition and medication because the patient cannot swallow liquids or food normally. Patients with dislodged or clogged PEG tubes often present to the emergency department (ED) or other acute care setting to have their tube removed or replaced.

ICD difference: When ICD-9-CM shifts to ICD-10-CM in Oct. 1, 2013, V55.1 will be converted into Z43.1 (Encounter for attention to gastrostomy). This will be a direct conversion with no significant changes in function.

Coder tips:

Contrary to popular misconceptions, you can use aftercare codes, such as Z43.1, as primary diagnosis. For instance, you would list them first on your claim in order to explain the specific reason for the encounter. Suppose the physician closed a "gastrocutaneous fistula," the site of an old PEG tube that has been removed. You should report K31.6 (Fistula of stomach and duodenum) instead of Z43.1. Why? The old PEG tube has been removed, so the code V55.1 is rendered out of context.