General Surgery Coding Alert

Question: Our surgeon went to the hospital to treat an admitted patient whose gastrojejunostomy tube had migrated to his stomach. The surgeon performed a problem-focused interval history and exam, then decided to perform an esophagogastroduodenoscopy (EGD) to reposition the tube. How should I code this scenario?

Utah Subscriber

Answer: Judging by your encounter description, the patient's percutaneous jejunostomy tube (J tube) slipped and became a percutaneous gastrostomy tube (G tube). On the claim, report the following:

• For the EGD, report 44373 -- Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to a percutaneous jejunostomy tube

• For the E/M, list 99231 -- Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused examination; medical decision making that is straightforward or of low complexity ...

• Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99231 to show that the E/M and tube fix were separate services

• List diagnosis code 569.69 -- Colostomy and enterostomy complications, other complication.

Explanation: The descriptor for 44373 might be a bit misleading, but it mentions only "tube conversion"; the tube does not necessarily have to be new.