General Surgery Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.   Question: The surgeon admits a patient and instructs the nurse to start an IV and place a nasogastric tube. The nurse, unable to place the tube, calls the surgeon. The surgeon returns, inserts the tube and starts the IV. How can the surgeon bill for his services?
Texas Subscriber     Answer: The surgeon can bill separately for the IV using 36410 (venipuncture necessitating a physician's skill [separate procedure], for diagnostic or therapeutic purposes) in addition to the appropriate-level hospital admission code (99221-99223), says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill. 
Until this year, there was no code for the insertion of a nasogastric tube by a physician, and the service was included in whatever E/M service was also provided (in this case, an admission). CPT 2001 introduced a new code (43752, naso- or oro-gastric tube placement, necessitating physician's skill), but HCFA has indicated it will not pay for this service and the Medicare fee schedule assigns no relative value units to this code -- making it unlikely the surgeon will get paid for this procedure. 
If 36410 and/or 43752 are billed, don't forget to append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the correct admission code, Mueller adds.