Gastroenterology Coding Alert

Answer: Yes. When your gastroenterologist places a naso-jejunal tube during an EGD procedure, you will have to report this procedure with 43241 (Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter). 

 

Many coders are confused about using 43241 for placement of a naso-jejunal tube, as the insertion of the tube occurs through the nose. CPT® 2014 added the terms “transoral,” which means through the mouth, and “flexible” to describe the type of scope used. However, the gastroenterologist conducts the EGD procedure with a specific aim of positioning the tube in the jejunum. So, even though the placement of the naso-jejunal feeding tube occurs through the nose, you need to report 43241, as your gastroenterologist performed the EGD through the mouth to grab the tip of the tube manipulating it for correct placement.

 

Modifiers: If your gastroenterologist has to retract the tube before finishing the procedure, you can attach either modifier 52 (Reduced services) or modifier 53 (Discontinued procedure) to the EGD code. Additionally, in CPT® 2014 updates, a qualification to the definition of EGD has been included in the new EGD guideline language to clarify the appropriate use of modifiers 52 and 53. If the GI deliberately does not examine the duodenum because of safety issues or significant gastric retention, you can append modifier 52 if repeat examination is not planned or modifier 53 if repeat examination is planned.

Other possible scenarios for use of the modifiers can be: 

You must explain the encounter to the payer as accurately as possible and the exact reasons that the gastroenterologist felt it was necessary to stop the EGD.