Gastroenterology Coding Alert

Question: One of our gastroenterologists performed an EGD on a patient on one day and a colonoscopy along with PEG tube removal on the following day. We reported 43235 for the EGD and 45378 for the colonoscopy. However, we cannot find a PEG tube removal code. Can you advise?

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Answer: You are right in reporting 43235 (Esophagogastro­duodenoscopy, flexible, transoral; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]) for the upper esophago­gastroduodenoscopy (EGD) procedure that your gastro­enterologist performed and 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed [separate procedure]) for the colonoscopy performed on the following day.

Unfortunately, there is no separate removal code for the removal of a PEG tube. If the PEG tube was removed and your gastroenterologist had no intention of placing another, then the removal becomes a part of the evaluation and management codes that you will be reporting for the visit.

One thing that you need to remember is that the tube removal is just a part of the E/M code that you are reporting and it should not become the basis for the level of E/M code that you are assigning for the visit. You should still assign the E/M level based on the standard components of history, examination and medical decision-making.

Since your gastroenterologist is conducting another procedure on the same day, it is best to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to the E/M code that you are reporting for the visit.

There are rare occasions when the physician must use an endoscope to remove portions of the G-tube. In these situations, you would report 43247 (Esophagogastroduo­denoscopy, flexible, transoral; with removal of foreign body[s]).