Refresh Your Tube Placement Expertise With Some FAQs
Published on Thu May 01, 2003
If your gastroenterologist places a feeding tube into the small bowel instead of the stomach, you need to make sure you recognize the difference between PEG and PEJ tube coding to receive appropriate reimbursement.
Various questions continue to arise in the coding world regarding the confusion in coding for PEG and PEJ placement or removal. Take a look at some frequently asked questions to see if you know how to decipher tube placement notes from the gasteroenterologist. Question 1: What is the difference between a PEG and a PEJ? Percutaneous endoscopic gastronomy (PEG) tubes are essentially feeding tubes used with patients who are unable to consume sufficient calories to meet metabolic needs. Physicians use this technique most often with patients who have impaired swallowing, neoplasms of the esophagus or larynx, and other catabolic conditions.
If needed, due to repeated aspiration of nasogastric tube feedings or other problems, the physician can modify the PEG technique to allow transpyloric placement of a jejunostomy tube at the time of the initial procedure or at a later time. The main difference is that the physician inserts the PEG tube percutaneously into the stomach with an endoscope, while he inserts the PEJ (percutaneous endoscopic jejunostomy) tube into the intestine to the jejunum, says Margaret Lamb, RHIT, CPC, Great Falls Clinic, Great Falls, Mont. Question 2: How should I code PEG tube placement? You report a PEG tube placement with 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube), says Stephanie Goodfellow, billing supervisor for Mid-America Gastro-Intestinal Consultants in Kansas City, Mo.
You may be confused when the doctor's notes refer to "buttons" PEG buttons or "Mickey" buttons. These are smaller, shorter tubes that the physician inserts through an established tract in the skin created by the standard PEG tube. The physician uses PEG buttons to replace a standard PEG tube after weeks or months when the original tube tract has matured. Therefore, you should report it as a PEG tube replacement, 43760* (Change of gastrostomy tube), Goodfellow says.
You might see tube descriptions that mention ports, balloons or bumpers. These are all tubes, and terms such as MIC and Bard are simply brand names. You always code initial placement of the tubes with 43246, and subsequent changes with 43760. Question 3:How Should I code PEJ tube placement? A PEJ tube is a longer tube that the physician inserts through the PEG into the small bowel rather than the stomach. Two scenarios could affect your coding.
Say the patient already has a PEG tube in place, and the physician has to convert it to a PEJ tube by going beyond the duodenum. According to [...]
