Gastroenterology Coding Alert

Question: Our physician performed an EGD with positioning and securing of jejunostomy tube. His findings consisted of a blocked feeding J tube that required forced irrigation to unblock the tube. The PEG part of the tube was secured on the abdominal wall with 4-0 Prolene stitch to prevent inward ingression. This is very confusing and would appreciate any input on this.

Orlando Subscriber

Answer: You have not mentioned why your physician performed the initial EGD procedure. But, in the scenario as you have described findings of a blocked J tube, it is assumed your physician performed the EGD to check and position of an already existing tube that had slipped.

Since he performed an EGD to view the existing tube, you’ll have to report this part of the procedure with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

During the procedure, since your physician observed that the existing tube was blocked, he removed the obstruction by forced irrigation. This part of the procedure you’ll have to report with 49460 (Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy [or other colonic] tube, any method, under fluoroscopic guidance including contrast injection[s], if performed, image documentation and report).

There is no Correct Coding Initiative (CCI) edits that bundle 43235 and 49460. So, there is no need to append any modifiers to either of the codes. Also, you need not report the securing of the tube using the Prolene stitch separately.