Gastroenterology Coding Alert

Question: My gastroenterologist treated a nursing home patient in the emergency department with a displaced G-tube and evidence of dehydration. She performed a detailed history and physical exam, ordered lab tests, and administered IV fluids for rehydration. Examination of the tube showed a significant clog. The gastroenterologist reviewed the lab tests, rehydrated the patient, and changed the Gtube. Which codes should I report on the claim?

Ohio Subscriber

Answer: On the claim, you should report:

• 43760 (Change of gastrostomy tube) for the tube replacement
• 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M service
• 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 99284 to show that the E/M service was separate from the G-tube replacement.

Warning: Don't assume the E/M level for any of your G-tube replacement patients. First, find out if the physician performed a separate E/M service. If she did, decide on the service level based on the notes she provides.