Gastroenterology Coding Alert

Question: We just saw a patient who had a worn out G-tube. The gastroenterologist removed the flange and then introduced a MIC tube, which she anchored with a balloon via gastroscope. Should we report 43247 for the removal? And then how do we report the insertion?

Puerto Rico Subscriber

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). Note that most gastrostomy removal and replacements are nonendoscopic and at bedside, and are reported typically with 43261 (Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple).

If the physician performed a separately identifiable E/M service in addition to the tube placement, you can also report an outpatient E/M code with 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.