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 was separate from the G-tube replacement.

Best bet: Don't assume the E/M level for any of your G-tube replacement patients. First, find out if the physician performed a separate E/M service. If she did, decide on the service level based on the notes she provides.

You should also use 43760 if the physician puts the same Gtube back into place. If your gastroenterologist treats a patient with a G-tube that has fallen out, and the gastroenterologist reinserts, you can still report 43760.

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Kathleen Mueller, RN, CPC, CCS-P, CMSCS, PCS, coding consultant in Lenzburg, Ill.