Wiki Removal of Peg (Not the surgeon that placed it)

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gniedermaier

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How would you bill for the removal of a peg tube if you are not the surgeon that originally placed it? 43235 with V55.1 or 43247 with 936? All replies appreciated. Thank You

Gina N, CMC
 
Depends on the work done and where. If done in the OR, 43870. If done in the office and dr just slide it out, part of E/M. If done in the office and dr had to do a lot of work, 43870 (depending on carrier) or 43999 for CMS. CMS has a place of service issue with 43870. They want it done in the OR. V55.1 should be fine.
 
By the term PEG (percutaneous endoscopic gastrostomy) tube, are you referring to a gastrostomy tube? If so, the only code you can charge for a removal is an E&M. There is no CPT code for just the removal of a G-Tube.
 
I am still unsure about this. A part of me agrees with both responses but it does not seem approriate to bill for an E&M code when you are performing an operative procedure. You are removing a peg that was not originally placed by you or anyone in your group. For any other type of procedure that does not have a specific code, you would choose an unlisted procedure code. I would appreciate any additional feedback since again, I am struggling with this. I am going to contact Medicare to find out if they can provide any addtional information. Thank You again for responding.

Gina Niedermaier, CMC
 
E & M code, doesn't matter if you doc didn't put it in, takes them a minute to pull a gastrostomy and they only take them to the OR if the site doesn't close on it's own, oh and your over thinking :)
 
If Dr is taking a patient to the OR they are no long doing an E/M, Dr is doing a procedure which dr should be properly reimbursed for.

Percutaneous endoscopic gastrostomy. Now you have a gastrostomy whether theres a tube there or not. If dr returns to the OR to repair the gastrostomy, I'd recommend you use code 43870 - Closure of a gastrostomy, surgical - That is what the code is for since Dr went to OR and surgically closed the gastrostomy. Code is specific to surgical so not to be confused with an E/M.
 
Please post the op note

For an accurate response to surgical coding questions, please post the scrubbed operative / procedure note.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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