Otolaryngology Coding Alert

Question: How do you code insertion of a nasogastric tube (NG) done in the emergency department (ED)?

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Answer: The answer depends on the kind of care provided in the ED. A new code (43752, naso- or oro-gastric tube placement, necessitating physicians skill) describes insertion of a nasogastric tube, but according to CPT guidelines this procedure should not be reported in conjunction with critical care codes 99291 or 99292.

Note: Neonatal intensive care codes 99295-99298 also bundle the insertion of a nasogastric tube.

Even if critical care services are not performed in the ED, obtaining reimbursement for nasogastric tube insertion may be difficult, says Teresa Thompson, CPC, an independent otolaryngology coding and reimbursement specialist in Sequim, Wash.

This service, which is usually performed by a nurse but is occasionally done by a physician due to the patients circumstances (hence the reference necessitating physicians skill in the codes descriptor), is considered an integral part of most procedures, and therefore should only be coded when performed at bedside or when no other procedure is performed.

HCFA does not associate any relative value units with 43752 and considers the service as always bundled into payment for evaluation and management services (E/M) or any other service provided to the patient. If the carrier doesnt cover 43752 and the otolaryngologist performed only the intubation, an appropriate low-level E/M code should be used.