Gastroenterology Coding Alert

Question: We scheduled a patient for a PEG exchange in the office. His tube had come out and a foley had been inserted. We attempted to place the new G tube but could not. The physician replaced the foley, and scheduled the patient for an EGD with PEG placement the next day at the hospital. Can we bill 43760 with modifier 53, or can we only bill for an office visit? Obviously, we cannot re-use the G tube and they are quite costly.››

Tennessee Subscriber

Answer: You should bill for an office visit (99211-99215, Established patient office or other outpatient services) mostly based on the amount of time involved in the failed attempt. No other service was actually completed. You can try to bill for the supply cost of the G tube separately using a HCPCS code for the tube (i.e., B4087, Gastrostomy/jejunostomy tube, standard, any material, any type, each) or a nonspecific supply code. Unfortunately, a denial may be hard to overturn.