Gastroenterology Coding Alert

Question: A patient with rectal bleeding presents in the gastroenterologist office. The doctor performs -gastric aspiration,- noting no blood in the contents. The physician also notes the -frequent flyer- status of this patient and suspects drug-seeking behavior. How should I report this case?

Illinois Subscriber Answer: You can report this procedure with 91105 (Gastric intubation, and aspiration or lavage for treatment [e.g., for ingested poisons]), and make sure you have a procedure note before doing so. Previously, you could have reported it using 43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation, and report]), but now the physician must perform fluoroscopic guidance to use this code.

Gastroenterologists perform gastric lavage procedures to find out whether a patient has active bleeding from the stomach, and the physician may place the tube either orally or nasally. In a case like this, she would probably insert the tube through the nose. Make sure there is proper documentation and a procedure note to reflect the medical necessity for the physician's involvement. Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.