Gastroenterology Coding Alert

There's more than one way to code a PEG tube placed by more than one gastroenterologist and with the increasing difficulty of getting reimbursed for four hands working on one placement, it's a good idea to be familiar with all of your options. To place a PEG tube, one physician performs an upper gastrointestinal endoscopy to locate the desired position along the wall of the stomach for the tube to be placed. The second physician then makes an incision at that position into the wall of the stomach. And finally, the PEG tube is put in place and secured with a retention disk. Here are three methods of coding PEG tube placements, some more widely accepted than others. Because there is such discrepancy from state to state on how this service should be coded, you're going to need to have more than one trick up your sleeve. Option 1: Use Modifier -62 Many coders turn to modifier -62 (Two surgeons) to code a two-physician percutaneous gastrostomy (PEG) tube placement, 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube).

"In Georgia, there's only one acceptable way to code a PEG placement by more than one physician, and that is to use modifier -62," says Linda Parks, MA, CPC, CCP, coding specialist for GI Diagnostics Endoscopy Center in Marietta, Ga. The rules. To use modifier -62, each surgeon must perform a distinct part of one procedure and must account for that operative work by appending modifier -62 to the code that best represents the service provided. The pros. According to the Medicare Carriers Manual (MCM), section 14046, each surgeon will receive 62.5 percent of the Medicare Physician Fee Schedule Database fee indicated for their service, Parks says. Another benefit of using modifier -62 is the indication in the Medicare Physician Fee Schedule Database that code 43246 may be performed by cosurgeons, indicated by the number 2 in Field 24 of the fee schedule. Also, this method of coding joint PEG-tube placement was recommended in the CPTAssistant, establishing this method as one of the most widely accepted means of coding for this service.

The cons. One potential disadvantage to using modifier -62 is having to coordinate the claims for each surgeon's services. One practice may not code the surgery as a cosurgery and may choose a code for only its physician's work rather than choose the code that represents the physicians'combined efforts with modifier -62, for example. Both surgeons have to use modifier -62 to report the service for the claim to be processed properly. Another potential drawback is that some carriers may have restrictions on what type of physician can [...]