ICD 10 Coding Alert

Question: How should I report a gastrostomy encounter in ICD-10?

Texas Subscriber

Answer:  When your general surgeon sees a patient for removal or reinsertion of an existing gastrostomy (G) tube, you should currently report V55.1 (Attention to gastrostomy) as the reason for the encounter.

ICD difference: When ICD-9-CM shifts to ICD-10 on Oct. 1, 2014, you can’t report V55.1 anymore. Instead, you should report ICD-10 code Z43.1 (Encounter for attention to gastrostomy). This will be a direct crosswalk between the two code sets with no significant changes in how you use the code.

Coder tips: Contrary to a popular misconception, you can use an aftercare code, such as Z43.1, as primary diagnosis. For instance, you would list the aftercare code first on your claim if the code describes the primary reason for the encounter, such as unplugging a G-tube.

Caveat: Suppose the surgeon closed a “gastrocutaneous fistula” at the site of an old G- tube that has been removed — should you report Z43.1? No. Because the G-tube has been removed, Z43.1 is no longer relevant. Instead, you should choose K31.6 (Fistula of stomach and duodenum).

Background: Patients typically have a G tube to provide nutrition or medication because the patient can’t swallow liquids or food normally. If the tube becomes clogged or dislodged, your surgeon might need to modify the tube to get it functioning again.