Gastroenterology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Which procedure code should I use to remove a PEG tube, or is it included in the placement of the tube? California Subscriber     Medicare and the Correct Coding Initiative (CCI) do not bundle the cost of the removal of a percutaneous gastrostomy (PEG) tube into the tube's placement fee. So, you can report the service based on the procedure used. For manual removal, you should report a low-level E/M code, probably 99212 (Established patient office visit). The doctor can qualify for a level-two service by meeting two criteria: a problem-focused history, a problem-focused examination or straightforward medical decision-making. He or she can qualify for 99212 by:

including a statement on the purpose for removing the tube (history) examining the abdomen around the tube and inspecting the condition of the tube tract after removal (examination). If complications such as bleeding or pain arise, the office visit may result in a higher-level E/M based on increased time, examination or decision-making. Some payers report reimbursement for 43750 (Percutaneous placement of gastrostomy tube) with modifier -52 (Reduced services). Because 43750 is a surgical code, you should ask your carriers if this is acceptable. You should definitely not append modifier -53 (Discontinued procedure) to 43750. Because the physician never planned to place a PEG tube, you would be reporting a partial unintended service, which is inappropriate. For endoscopic removal, often used with Ponsky-type tubes, you should assign 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body). You may link multiple diagnoses to whichever procedure you report. Possible diagnoses include the reason for the insertion for example, feeding problems (783.3) and the patient's current complaint for example, abdominal infection (536.41, Infection of gastrostomy). Note: 563.41 requires additional codes to identify the infection and organism.