Gastroenterology Coding Alert

Question: We recently hired a practice consultant who advised us that we are coding our PEG tube placements incorrectly. The gastroenterologist performs the EGD while the general surgeon works at the PEG. The physicians dictate separate procedure reports. We have always used a co-surgery modifier, but our consultant says that Medicare only recognizes this as an assistant surgeon procedure. She offered the option of one physician performing and dictating an EGD while the other reports the PEG tube placement. We have asked other practices and the AAPC and they disagree with the consultant and say we were coding correctly all along. How should we code this?

New Jersey Subscriber

Answer: Both physicians should report 43246-62 (Upper gastrointestinal endoscopy including ophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube).

You append modifier 62 (Two surgeons) when two physicians work together on the same procedure and both report the same CPT code.

Modifier 80 (Assistant surgeon) is not appropriate for this. The physicians are performing different parts of the procedure, not assisting one another. Under Medicare rules, a surgical assistant is paid 16 percent of the allowable.