Gastroenterology Coding Alert

Question: The provider removed an NG tube as he observed that the tube was in the esophagus and proximal stomach with clotted blood within it. He suctioned small amount of red blood which he could see, without causing any further bleeding. He mentioned that otherwise the upper third of esophagus, middle third of esophagus and lower third of esophagus were normal. How should I code for this nasogastric tube removal?

Utah Subscriber

Answer: If the provider performing the nasogastric tube removal is the same as the one who originally billed the NG-tube placement he cannot bill for it again. It is included in the E/M (office visit). However, if a provider were to remove the G-tube in the operating room, you might report the unlisted code 43999 (Unlisted procedure, stomach). Also, because you would be reporting an unlisted code you would have to submit the claim on paper along with a copy of the operative report describing the procedure.