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Gastroenterology Coding Alert

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Choose Foreign Body Removal Code For PEG Tube Removals

Published on Sun Nov 25, 2012

Question:If one of my doctors does and EGD with a PEG (43246) on a patient and at a later date removes that PEG via EGD would it be appropriate to bill an EGD with FBR (43247)? Michigan Subscriber Answer: You are right in your assumption of using 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) when a PEG tube is placed using EGD and using 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body) when it is removed using EGD. However, note that removal of PEG tubes is not always done using an EGD procedure and is many a time done manually. So, prior to using 43247, it is best to make sure that your doctors performed an EGD procedure and did not remove the tube manually. If it has been removed manually, you will not use a separate code to report the procedure and will only report the appropriate E/M code for the visit. Another instance would be that if your doctor could not pull out the tube percutaneously using traction, he might opt to sever the tube close to the stomach and then perform an EGD procedure to remove the rest of the tube remnant. In such a scenario, you will report the removal of the PEG tube using 43247. If your doctor opts to change the PEG tube using EGD, you will have to code 43247 for the removal and use 43246 for the new placement of the tube. However, do not forget to append modifier 59 (distinct procedural service) to 43247 as this is the lesser valued procedure (as per multiple endoscopy payer rules).  

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