Gastroenterology Coding Alert

Radiologic supervision and endoscopic guidance call for different codes Getting to know the whole story about your gastroenterologist's G-tube replacement procedure is what's going to keep you on the straight and narrow. Ignore the details, and you could report 43760 when you should be choosing a different code.
 
If a patient's gastrostomy tube (G-tube) suddenly malfunctions, he will likely be unable to get the liquids, nutrients or medications that he needs, creating an emergency. For this reason, many gastroenterologists often have to treat patients with malfunctioning G-tubes.
 
Who needs them? -G-tubes are necessary for patients who need enteric nutrition, or any patient unable to have any oral intake for a prolonged period of time,- says Margie Pfaff, CPC, corporate compliance analyst for Wisconsin's Medical Associates Health Centers.
 
Physicians may also administer medications through G-tubes, say Elijah Berg, MD, FACEP, chief operating officer of Medical Reimbursement Systems Inc. in Stoneham, Mass. Clogs in the Tube Cause Problems So how does a G-tube malfunction? According to Pfaff, when the liquid (fluids, medication, enteric nutrition, etc.) passes through the G-tube, it can clog, kink, dislodge or malposition the tube, creating the need for a replacement.
 
For proper G-tube replacement claims, you check the physician's notes:
 
- for evidence of possible separate E/M services the gastroenterologist might provide along with the G-tube service.
 
- to see if the physician used contrast monitoring during the procedure.
 
- for evidence of radiologic supervision and interpretation during the procedure. Only then can a coder choose the right G-tube code combination for the claim. You May Need a Separate E/M When the gastroenterologist replaces a G-tube, the contact usually involves a separate E/M, Berg says.
 
During this encounter, the physician is obligated to evaluate the patient for the presence or absence of an emergency medical condition, he says.
 
Patients with displaced or non-functioning G-tubes should have their hydration status and living situation evaluated, Berg says. Further, the physician should assess the appropriateness of the patient's current care and check if the patient missed any doses of medications.
 
-There is no cookbook answer as to what [E/M] level this could be,- Berg says.
 
For example: The gastroenterologist treats a nursing home patient in the emergency department with a displaced G-tube and evidence of dehydration. She performs a detailed history and physical exam, orders lab tests, and administers IV fluids for rehydration. Examination of the tube shows a significant clog. The gastroenterologist reviews the lab tests, rehydrates the patient and changes the G-tube. [...]