General Surgery Coding Alert

Question: In the past, we used 43750 for gastrostomy tube placement [CPT deleted 43750 for 2008]. Now, we must use 43246, but this code is not allowed with diagnostic endoscopy 43235. Is there any way that we can report the diagnostic endoscopy separately? Texas Subscriber Answer: No, you cannot unbundle the diagnostic endoscopy (43235, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) from the percutaneous endoscopic gastrostomy (PEG) tube placement (43246, ... with directed placement of percutaneous gastrostomy tube). Not only is 43235 a designated "separate procedure" -- and therefore only reportable when it occurs in the absence of any related, more extensive procedure -- but CPT instructions clearly state, "surgical endoscopy always includes diagnostic endoscopy." You may be able to report a diagnostic endoscopy if the surgeon replaces a gastrostomy tube percutaneously (43760, Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance) because of clogging or other factors. You must be sure, however, that the physician documents in the patient record the medical necessity for performing the endoscopy. If the physician does use the endoscope to place the feeding tube (rather than replacing the tube percutaneously), you should once again revert to 43246, according to CPT instructions. In this case, you would not report either 43760 or 43235.