Gastroenterology Coding Alert

Question: Our gastroenterologist meets an established Medicare patient with a malfunctioning gastrostomy tube (G tube) at the local hospital. The gastroenterologist performs a detailed history and physical exam, orders labs and IV fluids for rehydration, and admits the patient to inpatient status. Examination of the tube shows a significant clog. The gastroenterologist replaces the tube and uses radiological interpretation to guarantee proper tube placement. The physician decides to keep the patient in the hospital for monitoring. Can I report a code for the radiological interpretation?

Tennessee Subscriber

Answer: You should select a CPT code that represents both the G tube placement and the radiological service. On the claim, report the following:

• 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation) for the G tube replacement

• modifier 26 (Professional component) appended to 75984 to show you are only coding for your gastroenterologist's services

• 99218 (Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: a detailed or comprehensive history; a detailed or comprehensive examination; and medical decision making that is straightforward or of low complexity ...) for the E/M. When patients are admitted for observation care and then discharged on a different calendar date, the physician must use E/M codes 99218 through 99220 and observation discharge code 99217 (Observation care discharge day management ...).

• 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 99218 to show the insurer that the E/M was a separate service from the G tube replacement.