Unravel Complex G-tube Coding To Ensure Timely Payment
Published on Fri Sep 01, 2000
Even the most experienced radiology coders find reporting gastrostomy tube placement confusing. The pro-cedures are complex, and different coding options apply in different situations. According to Jeff Fulkerson, supervisor of radiology billing at the Emory Clinic in Decatur, Ga., Coders must understand what is being done and match the appropriate codes to the procedure.
Percutaneous gastrostomy tubes (G-tubes) are placed by an interventional radiologist to provide nutritional support to patients who have difficulty eating or swallowing, explains Elizabeth Kaese, CPC, coding specialist with Medi-Data Services Ltd., which provides billing and consulting services to radiology, gastroenterology, radiation oncology and cardiology practices in the Chicago area. The gastric tube is positioned directly in the stomach, while the gastrojejunal tube (GJ-tube) extends from the stomach into the jejunum, the portion of the small intestine between the duodenum and the ileum.
Both G- and GJ-tubes deliver liquid nutritional formulas directly into the digestive tract where they can be absorbed easily. Many GJ-tubes also have two lumens, Kaese adds, one that terminates in the jejunum and the other that terminates in the stomach. The G-tube or the gastric lumen of a GJ-tube also may be used to provide gastric drainage in cases of total or partial obstruction of the stomach.
Coding New G-tube and GJ-tube Placements
When a new gastric tube is placed, Fulkerson says, coders should report 43750 (percutaneous placement of gastronomy tube), according to conventions recommended by the Society for Cardiovascular and Interventional Radiology (SCVIR). 74350 (percutaneous placement of gastrostomy tube, radiological supervision and interpretation) also would be assigned.
If a new GJ-tube were being placed, coders may use one of two coding combinations:
43750 and 44373 (small intestinal endoscopy,
enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous
gastrostomy tube to percutaneous jejunostomy tube), or
43750 and 43761 (repositioning of the gastric
feeding tube, any method, through the duodenum for
enteric nutrition).
Either of these methods describes the procedure, which involves extending the reach of a gastrostomy tube by positioning the longer GJ-tube into the small intestine. While certain coding advisors recommend the first coding approach (43750 and 44373), the second combination (43750 and 43761) also may be used, according to Gary S. Dorfman, MD, FACR, FSCVIR, past president of SCVIR and president of Health Care Value Systems Inc. in North Kingstown, R.I., which provides practice management services as well as revenue enhancement techniques through coding and billing support.
The first coding approach has utility especially in cases in which an in-depth evaluation of the small bowel is performed during the tube placement procedure, he explains. Alternatively, if the second coding approach is used and an in-depth evaluation of the small bowel is also performed, the small [...]
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