ED Coding and Reimbursement Alert

Question: We have had problems getting paid when our ED doctors place NG tubes. What is the correct code to report? We have been using 43752. Florida Subscriber Answer: Your practice is reporting the correct code: 43752 (Naso- or oro-gastric tube placement, necessitating physicians skill). This code describes the ED physicians involvement when called on to place a feeding tube, typically a nursing service. Sometimes the nurse is not able to place the tube, and a physician provides the service. Reimbursement problems with 43752 have been reported since it was implemented in CPT 2001. It was then considered a welcome addition because there had been no way to report physician placement of an NG tube. However, CMS assigned no relative value units (RVUs) to the code on the Medicare Physician Fee Schedule. According to CMS, the lack of RVUs was based on a recommendation from the AMAs Relative Value Update Committee. As a result of this recommendation, 43752 was implemented with Medicare status code B, which indicates it is a bundled service and not separately payable; 43752 is bundled into E/M services. This policy created some misunderstanding among coders, who interpreted CMS position to automatically bill a feeding tube placement by physicians as an E/M service. This should be done only if the physicians services meet the requirements of the E/M code. Because E/M services are often performed and documented during an ED visit (e.g., 99284, Emergency department visit), the placement of the NG tube should be factored in when determining the level of E/M service.