General Surgery Coding Alert

Question: How can I code and get paid for a jejunostomy tube change? Someone suggested 43760-22, but Medicare requested records and ultimately denied the claim.


Michigan Subscriber

Answer: In spite of any advice you may have heard, CPT doesn't include a specific code or a code-and-modifier combination to describe a jejunostomy tube change. Therefore, your best bet is to call on an unlisted-procedure code, such as 43999 (Unlisted procedure, stomach).

Although 43760 (Change of gastrostomy tube) seems reasonably similar to changing a jejunostomy tube, close isn't good enough in this situation. CPT guidelines strictly state that you shouldn't select a "next best" code to describe a service if a dedicated code isn't available. Instead, you should select an appropriate unlisted- procedure code.

You can and should, however, compare the service you report with an unlisted-procedure code to a similar procedure that has a dedicated code. For instance, you could report 43999 for a jejunostomy tube change and include documentation with the claim stating, "This procedure is similar in difficulty and resources to that described by gastrostomy tube change 43760." In this way, the payer can make an informed decision regarding the pay rate for the procedure you are billing (for more information, see "You Supply Evidence for Unlisted- Procedure Pay," in an upcoming article).

A note about modifier 22: In almost every instance when you file a claim with modifier 22 (Unusual procedural services) appended, the payer will want to see full and supporting documentation. Save some time by manually filing all modifier 22 claims and automatically include the entire operative note, as well as a short letter describing how and why the procedure was "unusual." You should also include with your claim a request for additional compensation to match the extra time or effort the surgeon required to complete the procedure.