Radiology Coding Alert

Question: Our radiologist provided fluoroscopic guidance for an upper GI endoscopic procedure. The procedure reads as below:

“The stomach was inflated via nasogastric tube and punctured colon under fluoroscopic guidance. The GI tract was dilated and a gastrostomy tube pulled in place. The balloon was inflated and placement confirmed with contrast.”

How can we report these services? Is it appropriate to report 43246?

Ohio Subscriber

Answer: The code 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube) is for esophagogastroduodenoscopy. You should not report 43246 for the procedure described above. 

Your physician is attempting a percutaneous gastrostomy tube placement under fluoroscopic guidance. The correct code for the procedure is 49440 (Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection[s], image documentation and report). 

Note: The code 49440 includes all aspects of percutaneous gastrostomy, i.e. tube placement, fluoroscopic guidance, and contrast injection. Hence, you should not separately report any of these services.