Gastroenterology Coding Alert

Question: Our gastroenterologist treats a patient whose gastrojejunostomy tube has migrated to his stomach. The gastroenterologist perfoms a problem focused interval history and exam, after which he decides to perform an esophagogastroduodenoscopy (EGD) to reposition the tube. How should I code this scenario, considering there's no code for repositioning a G tube?

Kentucky Subscriber

Answer: Based on the scenario given, the patient's percutaneous jejunostomy tube (J tube) slipped and became a percutaneous gastrostomy tube (G tube). Here's how you should report it:

• 44373 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube) for the EGD;
• 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused examination; medical decision making that is straightforward or of low complexity ...) for the E/M;
• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99231 to show that the E/M and EGD were separate services; and
• 536.42 (Disorders of function of stomach; gastrostomy complications; mechanical complication of gastrostomy) appended to 44373 and 99231 to represent the patient's condition.

Careful: You could find 44373's descriptor misleading,  but keep in mind that it mentions only "tube conversion."The tube does not necessarily have to be new.