Gastroenterology Coding Alert
Presence of Earlier PEG will Decide PEJ Coding
Question: Our Gastro conducted a placement of a PEJ tube on a patient who already had a PEG tube. What code should I report?
Nevada Subscriber
Answer: You should code this encounter as 44373 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube). As the patient already had a PEG tube placed and your gastroenterologist converted an already placed gastrostomy tube into a jejunostomy tube via a percutaneous approach so that it extended into the distal duodenum, your selected code should be 44373. Your GI may have used moderate sedation along with local anesthesia.
The critical deciding factor is the presence of an earlier PEG tube in the patient. If no PEG tube would have been present in the patient, you would have reported 44372 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with placement of percutaneous jejunostomy tube).
Note: Sometimes, a GI may use “Miller-Abbott” tubes, which are longer than the PEJ and PEG tubes, and are often used when there is some sort of obstruction. When the gastroenterologist places a Miller-Abbott tube, report 44500 (Introduction of long gastrointestinal tube (eg, Miller-Abbott) [separate procedure]). The Miller-Abbott tube is not generally used for enteral feeding.
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