Gastroenterology Coding Alert

Learn to spot the differences between the procedures.

You’ve probably coded several encounters involving gastrointestinal (GI) tubes, so you probably also know tube coding is not always cut-and-dried. There’s placement, replacement, and maintenance to account for, and each type of tube service has its own set of rules.

Put your tubing code knowledge to the test by answering the following questions.

Question 1: How would you code the following procedure: The gastroenterologist inflated air into the stomach with the nasogastric tube, then punctured through the patient’s abdominal wall from the outside under fluoroscopic or ultrasound guidance. Then, they dilated the tract serially, inserted a GI tube using the pull technique, inflated the balloon, and confirmed intragastric placement with contrast injection without using an endoscope.

How would the coding change if the provider placed a jejunostomy tube at the same time, using fluoroscopic guidance to confirm placement?

Question 2: Which code is most appropriate for percutaneous insertion of a duodenostomy or jejunostomy tube? Which code is used for the replacement of this tube?

Question 3: Which code is most appropriate for percutaneous insertion of a cecostomy or other colonic tube? Which code would you use for the replacement of this tube?

Question 4: Code the following procedure: The gastroenterologist replaces a dislodged gastrostomy tube (G-tube) through the well-established percutaneous tract. The physician aspirates gastric contents to confirm the tube is safely in the stomach.

Question 5: How would you code the above scenario if the gastroenterologist was removing obstructive material from the G-tube instead of replacing it? What if they removed the tube entirely and didn’t replace it?

Question 6: How would you code the following: The gastroenterologist removed a percutaneous endoscopic gastrostomy (PEG) tube in the office but had a hard time removing the tube. The tube had to be cut close to the stomach, and then the provider performed a diagnostic endoscopy to get a closer look at retrieve the tube remnant. Then the provider replaced the PEG tube.

Think you know the answers? Click here to know the Answers.