Gastroenterology Coding Alert

Question: What is the appropriate CPT code for an EGD and Keofeed tube insertion into the jejunum? The patient has a fistulous tract in the duodenal bulb. Also, the doctor performed EUS in the pancreas. I would code 43259, but I'm not sure about the tube insertion. California SubscriberAnswer: It sounds as if your gastroenterologist is performing 43259 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate) and 43241 (... with transendoscopic intraluminal tube or catheter placement). You should report both of the codes.Signposts: Keofeed indicates a feeding tube that runs down the patient's nose, esophagus, and stomach, and into the small intestine. It shows that your doctor isn't performing a percutaneous endoscopic gastrostomy -- poking a hole in the patient ��" to insert the tube, for which there are different codes. Exempt from modifier: Many payers -- including most Medicare carriers -- don't want you to append modifier 51. The payer will automatically sort the procedures on your claim in order from highest to lowest RVUs. The carrier will pay the highest-ranked procedure at 100 percent and any additional surgical procedures in the same family of codes after subtracting the base code, 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate ...), from the service.