Otolaryngology Coding Alert

Question: After a neonatal nurse couldn't insert a nasogastric tube into a critically ill neonate, a neonatologist requests that our otolaryngologist perform the procedure in the neonatal intensive care unit. Should I report the tube insertion?

South Carolina Subscriber

Answer: Since the otolaryngologist doesn't provide neonatal critical/intensive care (99295-99298), you should report 43752 (Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance) for the tube placement. When the same physician performs both the procedure and the E/M service, CPT includes nasogastric tube insertion in neonatal critical/intensive care codes (99295-99298) and critical care codes (99291-99292). In these cases, CPT considers 43752 an integral part of neonatal intensive care, as well as critical care.
 
But when nasogastric tube insertion requires a physician's skill, as in your example, and the physician performs the procedure alone or at the patient's bedside, you should separately report the procedure.