Gastroenterology Coding Alert

Question: Medicare will not pay separately for a PEG tube (that is, the tube itself, not the replacement). Is it appropriate to have the patient sign an ABN and pay for the supplies out-of-pocket?


New York Subscriber

Answer: No, you should not ask the patient to sign an advance beneficiary notice (ABN) asking him to pay separately for supplies.

Medicare bundles the cost of the PEG tube and other supplies into the facility reimbursement for 43760 (Change of gastrostomy tube) when the gastroenterologist performs the replacement in a hospital or ambulatory surgical setting. If you provide the procedure in an office setting, the fee schedule allows higher payment for the gastrostomy replacement that includes the supplies.

For endoscopic placement, you may report 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Payment for the original PEG tube and insertion supplies is once again included in the fee paid to the facility.

However, in this case, there is no -site of service- differential, as with 43760. Therefore, if you perform this procedure in the office, you will have to pay for the supplies yourself without additional compensation.

If you break out the cost of the tube and try to charge the patient separately, you are -double-dipping,- as defined by Medicare rules. This is an abusive practice that could lead to penalties.