General Surgery Coding Alert

Question: The surgeon performed an EGD with positioning and securing of jejunostomy tube. His findings consisted of a blocked feeding J tube that required forced irrigation to unblock the tube. The PEG part of the tube was secured on the abdominal wall with 4-0 Prolene stitch to prevent inward ingression. How should we code this?

Florida Subscriber

Answer: Based on your description, it appears that the surgeon performed the procedure to check and reposition an already existing J tube that had slipped.

Assuming that the surgeon performed an esophagogastroduodenoscopy (EGD) to view the existing tube, you’ll have to report this part of the procedure with 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]).

During the procedure, your surgeon observed that the existing tube was blocked, and he removed the obstruction by forced irrigation. You should report this part of the procedure as 49460 (Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy [or other colonic] tube, any method, under fluoroscopic guidance including contrast injection[s], if performed, image documentation and report).

You do not need to use any modifiers to report these two codes together, because Correct Coding Initiative (CCI) doesn’t bundle these codes. Also, you should not separately code for securing the tube using the Prolene stitch.