General Surgery Coding Alert

Question:

Texas Subscriber

Answer:

An appropriate diagnosis code would be 537.4 (Fistula of stomach or duodenum). You should report the procedure as 43870 (Closure of gastrostomy, surgical).

You should not use V55.1 (Attention to gastrostomy) as the diagnosis code because the old percutaneous endoscopic gastrostomy (PEG) tube has been removed.

Report specific procedure: The name, "gastrocutaneous fistula," does not provide enough information to determine the surgical procedure code. However, the documentation of the source and depth of the wound, along with the steps the surgeon took to resolve the condition leads to the appropriate procedure code 43870.

Although you would typically report 43870 for a gastrostomy closure immediately following the PEG tube removal, your surgeon essentially performed the same procedure for an old gastrostomy site that had not healed properly. That's why you should use the more specific code for the procedure instead of an unlisted code such as 43999 (Unlisted procedure, stomach).