Gastroenterology Coding Alert

Question: Can a nurse change out a percutaneous PEG tube in the office? If so does a physician need to be in the office area at time of the change and would we bill under the physician who is providing the care of the patient?

New York Subscriber

Answer: The appropriately trained registered nurse or licensed practical nurse may replace a gastrostomy tube, provided the following criteria are met:

• The licensed nurse is educated and competent in the procedure. This education and competence must be documented initially and on an ongoing basis;
• There is a medical order for the procedure, including the type tube to be used for replacement;
• There are no contraindications related to the patient's condition;
• The licensed nurse practices according to accepted standards of practice;
• There is a well-healed tract without sign/symptoms of infections; and
• The facility has policies procedure in place addressing all aspects of the issue.

Note: A trained nurse can replace a PEG tube and it does not list the necessity of the physician being present for the procedure.