General Surgery Coding Alert

Question: Which code should I use for a PEG tube removal in the office? Should I use a foreign-body removal code?

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Answer: You cannot report a separate code for simple percutaneous endoscopic gastrostomy (PEG) tube removal because CPT contains no such code. If the surgeon removes the tube only, you can report only an appropriate-level outpatient E/M code (99201-99215). Specifically, for a removal in the office for an established patient, select from among the outpatient E/M codes 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient -).

You definitely should not report 43247 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with removal of foreign body) for PEG tube removal. Removing a PEG tube does not generally qualify as foreign-body removal.

Exception: You may report 43247 if the surgeon must perform a scope to retrieve a broken portion of a PEG tube that remains in the stomach.

- If the surgeon must perform a diagnostic endoscopy to remove the tube (due to complications, for instance), you may report the appropriate endoscopic procedure code: 43200, Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure); or 43235, Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure). But the surgeon must document the unusual circumstances that required the endoscope's use.