Gastroenterology Coding Alert

Question: When we do a percutaneous gastrostomy (PEG) tube placement, the gastroenterologist is usually assisted by another gastroenterologist. Does the gastroenterologist doing the assisting have to do his own documentation?

Alabama Subscriber

Answer: The assisting gastroenterologist does not have to do separate documentation. But the attending gastroenterologist should list the procedure and who was assisting in the patients medical record.

When billing for this procedure, each gastroenterologist should report code 43246 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) with modifier -62 (two surgeons) attached. Sections 4828 (C.6) and 15046 of the Medicare Carriers Manual state that each physician involved in a co-surgery procedure will receive 62.5 percent of the fee schedule amount.

For more on billing for the insertion or removal of PEG tubes, see Method of Insertion or Removal Determines Amount of Payment for PEG Tube Procedures on page 49 of the July 2000 Gastroenterology Coding Alert.