Gastroenterology Coding Alert

Question: Our gastroenterologist removed a percutaneous endoscopic gastrostomy (PEG) tube in the office but had a hard time removing the tube. She cut the tube close to the stomach, and then then performed a diagnostic endoscopy to get a closer look and retrieve the tube remnant. Then she replaced the PEG tube. How should I code this procedure?

Maine Subscriber

Answer: If your provider removes the tube remnant by endoscopy, you report the endoscopy with 43247 (Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)). Placement of the new gastrostomy tube would be reported with 43246-59 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube; Distinct procedural service) since it did involve endoscopic guidance.

Note: Make sure the notes clearly state the medical necessity of the endoscopy. National Correct Coding Initiative (NCCI) edits state that intubating the GI tract includes subsequent removal of the tube. Because of this, you need to make it clear why the provider had to go above and beyond the standard procedure.