Gastroenterology Coding Alert

Question: The gastroenterologist meets an established patient in the hospital to treat a malfunctioning gastrostomy tube (G tube). The gastroenterologist inserted the tube three weeks ago, and notes indicate that it just "popped out of place." After a level-two E/M, the gastroenterologist removes the old tube and installs a new one; to ensure proper placement, he uses contrast monitoring during the re-insertion. Is the monitoring part of the G tube placement, or can I code it separately? Florida Subscriber Answer: You should choose a single code for the replacement and the monitoring. On the claim, report the following: • 49450 (Replacement of gastrostomy or cecostomy [or other colonic] tube, percutaneous, under fluoroscopic guidance including contrast injection[s]; image documentation and report]) for the replacement • modifier 26 (Professional component) appended to 49450 to show that you are only coding for your physician's role in the monitoring • 99212 (Office or other [...]