Gastroenterology Coding Alert

Question: How can I report removal of a PEG tube?


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Answer: The gastroenterologist can receive payment for the PEG tube removal if he replaces the tube at the same time. In this case, you should report the removal and replacement using 43760 (Change of gastrostomy tube) if the physician replaced the PEG tube manually.

For endoscopic PEG tube replacement, report an esophagogastroduodenoscopy (EGD) with foreign-body removal and report the PEG replacement with 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube).

If the doctor removes the tube without replacing it, however, the removal is included as a part of any E/M services provided. When determining the level of the E/M service, you should assign the level based on the standard components of history, examination and medical decision-making.

Exception: If the PEG tube breaks off during the removal, you may have to report a foreign-body removal (43247, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body).