Gastroenterology Coding Alert

Question: One of our gastroenterologists replaced a gastrostomy tube with a Mic-Key button. How should we code for that procedure?

Missouri Subscriber

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

  Answer: The Mic-Key button is a low-profile gastrostomy tube that lies closer to the skin than a regular gastrostomy tube. In most cases, this type of change can be done manually and should be reported with code 43760 (change of gastrostomy tube).

If the change was done endoscopically, then you may use code 43247 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with removal of foreign body) to report the removal and code 43246 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate, with directed placement of percutaneous gastrostomy tube) to report the placement.

According to the Medicares multiple endoscopies payment rule, code 43246 should be reimbursed at 100 percent of its allowable fee because it is the higher- valued procedure with a transitioned facility relative value unit (RVU) of 7.97. Modifier -51 (multiple procedures) should be attached to code 43247 because it is the lesser-valued procedure with a transitioned facility RVU of 6.23. Reimbursement should be the difference between the allowed fee for code 43247 and its endoscopic base code 43235. Some payers may require the use of modifier -59 (distinct procedural service) instead of or in addition to modifier -51.

For Medicare patients, code 43760 should not be reported in addition to codes 43246 and 43247 when the gastrostomy tube change is done endoscopically because it is bundled into both codes by the Correct Coding Initiative . When bundled codes are submitted, Medicare carriers have the option of reimbursing the lesser-valued procedure, which in this situation is code 43760 with a transitioned facility RVU of 1.74.