Wiki EGD with PEG Tube Removal and Replacement

[aforsythe]

Report States...
The esophageal mucosa appeared normal.
Stomach is entered; the mucosa, the cardia body, and antrum appeared normal. PEG Tube was noted on the anterior wall of the body of the stomach.
Duodenal bulb as well as descending duodenum were within normal limits.
On withdrawal of the instrument, a ROTH Net was placed around the PEG Tube anchor. The PEG Tube was cut outside the abdominal wall and removed. A 20 French replacement feeding tube was then introduced and inflated. It was seen in good position. The PEG Tube bumper was then removed and discarded.
The patient tolerated the procedure well.

Patient has a stroke and PEG Tube needed replaced due to tube issues with already placed PEG.

Is everyone only billing the 43246 for the PEG Tube or should an EGD with Foreign Body Removal also be billed with this?

We have several different thoughts.

Thank you.

 

[tkermode]

Per ASGE:

Question #1
If a peg tube were removed due to a malfunction and a new one was placed, would I use CPT code 43246 (EGD with PEG insertion) and 43247 (EGD with foreign body removal) or just 43246?
Answer
If you are removing and replacing the PEG via endoscopy, use code CPT 43246 only and note in box 19 of the claim form "Endoscopic PEG tube removal and replacement." If the replacement was not done endoscopically, then CPT code 43762 would be appropriate.

https://www.asge.org/home/resources...---july-2023-answers-to-your-coding-questions

Per AAPC:

The procedure you describe involves your surgeon replacing a feeding tube that runs through the patient's skin straight into the stomach. The removal of the old PEG tube is incidental to its replacement, so you only need the one code.

https://www.aapc.com/codes/coding-n...fWT2yCZxFiU-tXo2IXa9AS3vFqyGY2vviajAi8C7rAo3W

Per CPT Assistant June 2022:

Endoscopic G-tube replacement is reported with code 43246. This code does not specify whether the procedure is an initial G-tube placement or the replacement of a G-tube; the same code is reported in both scenarios. Note that endoscopic G-tube replacement described by code 43246 includes the removal of a G-tube when performed, which may not be separately reported.