Gastroenterology Coding Alert
You Be the Coder How to Code PEG Versus PEJ Tube Placement
Question: How should I code for the placement of a Bard Peg Jejunal extension tube? This procedure is being performed because of the patient's intolerance of PEG feeding due to gastroparesis. The operative notes say that the tube was grasped with biopsy forceps, dragged into the jejunum, and released to be left in the jejunum. Minnesota Subscriber Answer: The placement of a percutaneous endoscopic gastrostomy (PEG) tube is reported with 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube). Gastroenterologists also use percutaneous endoscopic jejunostomy (PEJ) tubes that are passed through the PEG tube into the small bowel. The physician can convert the PEG tube into a PEJ tube by going beyond the duodenum. Therefore, if this PEJ tube is simply an "extension" since the patient already has a PEG tube, you should use 44373 (Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube).
Gastroenterology Coding Alert
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