Gastroenterology Coding Alert

Question: My gastroenterologist manually removed a percutaneous gastrostomy (PEG) tube from an established patient; this was a simple procedure done in-office. What can I report for this service?California Subscriber Answer: CPT does not include a procedure code for basic PEG tube removal. However, when your gastroenterologist removes a PEG tube manually with no complications, it is usually a level-two E/M service.- In your scenario, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making).- Exceptions: Before reporting this service, double-check the operative note, because you must know what technique the physician used to remove the tube. A physician can remove a PEG tube one of two ways: Certain types of tubes dictate endoscopic removal, while others are designed for manual removal in the office.- Also, if complications arise and the gastro can't remove the tube manually, he may have to perform an endoscopy to take the tube out.- If the gastroenterologist has to remove a PEG tube endoscopically, use 43247 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with removal of foreign body).