General Surgery Coding Alert
Distinguish EGD and PEG Procedures
Question: Should I code the following note as 43246?
“The stomach was inflated via nasogastric tube and punctured colon under fluoroscopic guidance. The GI tract was dilated and a gastrostomy tube pulled in place. The balloon was inflated and placement confirmed with contrast.”
Answer: No, you should not list 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) for the procedure you describe.
The surgical note does not document an esophagogastroduodenoscopy (EGD) procedure, which is what 43246 describes. Instead, you’ve given a description of a percutaneous gastrostomy tube placement under fluoroscopic guidance.
The correct code for the procedure is 49440 (Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection[s], image documentation and report). You’ll notice that the code includes all aspects of the procedure — tube placement, fluoroscopic guidance, and contrast injection — so you shouldn’t separately report those services.
Background: Surgeons typically place a gastrostomy tube, or G-tube, into the stomach for long-term food and medication administration. The most common type is a percutaneous endoscopic gastrostomy (PEG) tube.
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Question: Should I code the following note as 43246?
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