Wiki CPT Code 43762

[Skymom16]

Need Help or clarification

I have billed new CPT Code 43762 (peg exchange ) I added Modifer 52 due to Dr removed and exchange the peg after trying to replace the new peg (that we provided ) the size was incorrect therefor dr place the old peg .Note patient was a Medicare /HMO that we do not accept and was send from a nursing facility . I billed an E&M code along . Now I received a called from director of the facility stating that we are committing fraud due to the peg exchange (note they were aware of what happened ) and we have our documentation supporting this ?! Am I wrong to Bill the peg with mod 52 ?? Please help

 

[chaxton]

Good Morning,

Based on your comments I would say the facility director does not have a current understanding of CPT 43762 since it is new this year. I have included a cut and paste below from the Optum EncoderPro software on this code maybe this will help.


43762
Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract

Lay Description (Code):

In 43762, the physician replaces a gastrostomy tube via percutaneous approach that does not require revision (simple) of the gastrostomy tract. If the old gastrostomy tube has been placed endoscopically, the physician must remove it by snaring and pulling it out through the mouth. A new tube is placed percutaneously through the abdominal wall via the existing tract. In 43763, the replacement requires revision (complex). A small incision is made through the skin and fascia. A large bore needle with suture attached is passed through the incision into the lumen of the stomach. The needle is snared and the needle and suture are removed via the mouth. The gastrostomy tube is connected to the suture and passed through the mouth into the stomach and out the abdominal wall. The gastrostomy tube is sutured to the skin. No imaging or endoscopic guidance is utilized in either procedure.

Coding Tips

For percutaneous replacement of a gastrostomy tube using fluoroscopy, see 49450; endoscopic placement of a gastrostomy tube, see 43246. It is inappropriate to report supplies when these services are performed in an emergency room. For physician offices, supplies may be reported with the appropriate HCPCS Level II code. Check with the specific payer to determine coverage.

 

[Skymom16]

Thank you for your reply . I was doubting myself ( i should had known better). Was modifier 52 ok to appended ?