General Surgery Coding Alert

Question: Our surgeon sometimes changes a gastrostomy tube in the office. Should we code 43760 for the service, and can we bill separately for materials used for the new G-tube?

Virginia Subscriber

Answer: Yes, 43760 (Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance) is the appropriate code to describe the service.

Regarding materials, because the procedure is in the physician office, not a facility, you may separately report the G-tube using one of the following HCPCS level II codes:

• B4087 -- Gastrostomy/jejunostomy tube, standard, any material, any type, each
• B4088 -- ... low profile, any material, any type, each.

Don't miss E/M: In addition to charging 43760 for percutaneously removing and replacing a percutaneous endoscopic gastrostomy (PEG) tube in the physician office, you should also code for any distinct, separately identifiable E/M service on the same day (such as 99213) if the surgeon documents the work. You'll need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.