Wiki Removal of Gastrostomy Tube

[bethh05]

The GI physician removed G-Tubes on 2 patients no EGD or anything just the removal of the tube. I know there is not a code for this procedure, but everything I have read states that it is included in the E/M. Since it is in an ASC could we bill anything for this? Thank You

 

[capricew]

it depends on your contract with the insurance for the two patients the physician did this for.
Medicare will not allow E/M codes at an asc such as 99214.

most insurances will follow this criteria. however, i have some contracts that if the code that was performed is not on their list of payable codes for an asc, then we get reimbursed at 40% of billed amount up to a maximum payable.
it would be best for you to talk to the person at your facility who maintains your contracts and ask him/her to get the OPG lists for each individual commercial insurance. Then talk to your contractor and understand how your contracts will pay you if a code is not on that list.

hope this helps
caprice w. cpc