Gastroenterology Coding Alert

Question: A gastroenterologist in our office met an established patient at the hospital for placement of a percutaneous gastrostomy (PEG) tube. Five days after the procedure, the patient had complications due to the tube. Our gastro was called in to consult; she performed a level-three confirmatory consultation, and another surgeon handled the procedure. Can we report a separate consultation, or is it included in the surgical global package?

Montana Subscriber

Answer: If you billed the PEG placement with 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube), there is no global period; therefore, you can report the consultation separately.

If your office bills a PEG placement with 43246, you can report 99273 (Confirmatory consultation for a new or established patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of low complexity) for the consult.

- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, coding and billing coordinator for GI Diagnostic Endoscopy Center in Marietta, Ga.