General Surgery Coding Alert

Reader Questions:

Don’t Let Endoscopy Fool You

Published on Mon Sep 19, 2022

Question: Using a nasogastric tube, the surgeon inflated the abdomen, then punctured the patient’s abdominal wall for access. Using fluoroscopic guidance, the surgeon serially dilated the GI tract and inserted a GI tube using pull technique. After inflating the balloon, the surgeon confirmed intragastric placement using contrast injection. How should we code this?

Mississippi Subscriber

Answer: The best choice for this scenario is 49440 (Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report).

Here’s why: The procedure description you provided makes no mention of endoscopy, so you should not use 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube), which is a common code for percutaneous gastrostomy (PEG) tube placement during an esophagogastroduodenoscopy (EGD) procedure.

Details: You description does describe fluoroscopic guidance and contrast injection to ensure proper PEG tube placement.

Payment: If your surgeon performed this in the office, the payment for 49440 would be $891.11 (Medicare Physician Fee Schedule national non-facility amount, conversion factor 34.6062). The EGD code 43246, on the other hand, pays $203.14 for both the facility or non-facility. Getting the correct code for this service is crucial for appropriate payment.