Gastroenterology Coding Alert

Question: The gastroenterologist treated a nursing home patient in the emergency department (ED) with a displaced G-tube and evidence of dehydration. She performed a detailed history and physical exam, ordered lab tests, and administered IV fluids for rehydration. Examination of the tube showed a significant clog. The gastroenterologist reviewed the lab tests, rehydrated the patient, and changed the G-tube. How should I report this encounter? Arizona Subscriber Answer: On the claim, you should: Report 43760 (Change of gastrostomy tube) for the tube replacement. Report 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M service. Attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99284 to show that the E/M service [...]