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General Surgery Coding Alert

You Be the Coder:

537.4 Trumps V55.1 for Old PEG Site

Published on Mon Jan 24, 2011

Question:Our surgeon closed a "gastrocutaneous fistula," which is actually the site of an old PEG tube that has been removed. The patient has intermittent drainage of gastric contents. With the patient under general anesthesia, the surgeon dissected the fistula tract from the surrounding subcutaneous tissue and fascia, ligating the juncture with the stomach and removing the tract before suturing the fascia and subcutaneous tissue. What are the correct diagnosis and procedure codes?Texas SubscriberAnswer:An appropriate diagnosis code would be 537.4 (Fistula of stomach or duodenum). You should report the procedure as 43870 (Closure of gastrostomy, surgical).You should not use V55.1 (Attention to gastrostomy) as the diagnosis code because the old percutaneous endoscopic gastrostomy (PEG) tube has been removed. Report specific procedure: The name, "gastrocutaneous fistula," does not provide enough information to determine the surgical procedure code. However, the documentation of the source and depth of the wound, along with the steps [...]
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