Gastroenterology Coding Alert

Question: An ambulance brought in a middle-aged male with a dislodged G tube from the nursing home. The gastroenterologist ordered a replacement G-tube to the bedside and placed it through the well-established percutaneous tract. After placement, the physician aspirated gastric contents, confirming that the tube was safely within the stomach. Which codes apply?

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Answer: The appropriate code to report this encounter would be 43762 (Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract) because you did not mention performing any fluoroscopic guidance. This code applies when the gastroenter­ologist doesn’t have to revise the gastrostomy tract during the replacement, which appears to be the case based on the description in the question.

If the GI did use fluoroscopy during the procedure, then you should instead report 49450 (Replacement of gastrostomy or cecostomy [or other colonic] tube, percutaneous, under fluoroscopic guidance including contrast injection[s], image documentation and report). This describes any work the physician performs when replacing a gastrostomy, cecostomy, or other colonic tube under fluoroscopic guidance.