Gastroenterology Coding Alert

Question: According to the op note, the provider inserted the gastroscope to the body of the stomach. He identified a flange of worn out G-tube and removed it. Under direct visualization, he introduced a MIC tube anchored it with a balloon. How do I bill for this procedure? Can I bill 43247 for removal of the old tube?

Utah Subscriber.

Answer: Code 43247 stands for (Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body[s]), and it does not apply in the given scenario. When you are replacing an old tube with a new one, the removal is included in the procedure. You do not need to report a separate code for removal per se. You need to report just one code 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube). For placement of these shorter tubes, such as MIC, you would report 43246.