General Surgery Coding Alert

Question: How should we code the following procedure? The surgeon replaced a dislodged gastrostomy tube (G-tube) through the well-established percutaneous tract. The surgeon aspirated gastric contents to confirm the tube is safely in the stomach.

Texas Subscriber

Answer: Look to 43762 (Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract) for this case, as you have no documentation that the surgeon used imaging, and the notes make no mention of the provider revising the gastrostomy tract.

Caveat: If the provider replaces a G-tube during initial placement procedure’s 10-day global period, append modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period). If replacement occurs outside of the global period, you don’t need a modifier. The modifier requirement also applies to the tube codes with fluoroscopic guidance. However, endoscopy gastrostomy 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube) has a 0-day global period so you could ignore modifier 79 for that procedure.