kyannekis
Networker
What ICD 9 Codes are used when a patient pulls out the G Tube and you do the replacement? Is this considered a mechanical complication or just the V55.1 code?
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Wiki G Tube replacement
- Thread starter kyannekis
- Start date
vjtiwari99
Guru
Hey,
I think 536.42 plus V55.1.
As per mkj2486, "A mechanical complication would be if the G tube itself has a problem. In this case the patient is the problem". But even patient pull the G tube or the G tube is fell out (or as per the given info.) the G tube have complications & so replaced. Hence I coded as above.
Hope this helps!
VJ.
I think 536.42 plus V55.1.
As per mkj2486, "A mechanical complication would be if the G tube itself has a problem. In this case the patient is the problem". But even patient pull the G tube or the G tube is fell out (or as per the given info.) the G tube have complications & so replaced. Hence I coded as above.
Hope this helps!
VJ.
Last edited:
suemt
Expert
I found this information:
EX 3: PATIENT PRESENTS TO ED BECAUSE THEY PULLED OUT THEIR G-TUBE AND SAME TUBE IS REINSERTED IN THE ED. DX: REPLACE G-TUBE
Answer: Assign code V55.1, Attention to gastrostomy, as the principal
diagnosis. There are no complications with the gastrostomy, therefore, no
complication code is appropriate for this case.
Here is the reference: http://www.cditalk.com/content/223-Gastrostomy-Complications
EX 3: PATIENT PRESENTS TO ED BECAUSE THEY PULLED OUT THEIR G-TUBE AND SAME TUBE IS REINSERTED IN THE ED. DX: REPLACE G-TUBE
Answer: Assign code V55.1, Attention to gastrostomy, as the principal
diagnosis. There are no complications with the gastrostomy, therefore, no
complication code is appropriate for this case.
Here is the reference: http://www.cditalk.com/content/223-Gastrostomy-Complications
suemt
Expert
What CPT code to use?
when the patient pulls out the tube and it is just reinserted (not surgically)?
49450 and 43760 don't seem to fit.
This is the question I was searching for when I happened upon this thread.
when the patient pulls out the tube and it is just reinserted (not surgically)?
49450 and 43760 don't seem to fit.
This is the question I was searching for when I happened upon this thread.
bridgettemartin
Expert
Like Melissa, we use 43760, with 536.49 when a patient pulls out their PEG, and it is manually replaced without the use of a scope.
mitchellde
True Blue
Just to replace the G tube is not a complication! If the reason for the encounter is just to remove and/or replace the G tube the correct code is the V55.1. A coder cannot diagnose a complication when the provider has not indicated that one exists.
Last edited:
suemt
Expert
Hi, Debra. Thanks for weighing in on this. I value your opinion, and agree with you on the V55.1 Dx.
My question is the CPT, and I'm thinking by the description that it would be considered part of the E/M visit.
This was not even the specific reason for the visit, it was part of a regular home visit, and the provider just had one fraction of a sentence in the note "reinserted PEG". I'm having a hard time justifying coding the 43760 with a $400 reimbursement for what sounds like the provider just popped a tube into a port. Also, the description says "change" gastronomy tube, not reinsert the one that the patient pulled out.
My question is the CPT, and I'm thinking by the description that it would be considered part of the E/M visit.
This was not even the specific reason for the visit, it was part of a regular home visit, and the provider just had one fraction of a sentence in the note "reinserted PEG". I'm having a hard time justifying coding the 43760 with a $400 reimbursement for what sounds like the provider just popped a tube into a port. Also, the description says "change" gastronomy tube, not reinsert the one that the patient pulled out.
2008 CPT Assistant Answers this question.
Year: 2008
Issue: April
Pages: -11
Title: Coding Consultation: Questions and Answers
Body: Surgery: Digestive System
Question: A patient presented with a clogged gastrostomy tube. After examining the existing tube site, the physician deflated the balloon. The existing gastrostomy tube was removed. A new balloon tube was tested and inserted without the use of fluoroscopic guidance. What is the appropriate code to report for this procedure?
Answer: The appropriate code to report for this procedure is code 43760, Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance.
My question is a clogged tube a complication of the original placement? We have a scenario where the patient had one placed in an open fashion, comes to the office with a clogged catheter and the provider replaces it. If this is a complication, I cannot use modifier 78 for the office replacement (place of service 11), so does a replacement then become routine post operative care and not separately billable or is modifier 79 applicable?
Does a clogged gastrostomy tube fall into the services included in the global surgery payment as per Medicare?
All additional medical or surgical services
required of the surgeon during the post-operative
period of the surgery because of complications,
which do not require additional trips to the
operating room;
Or is it
Clearly distinct surgical procedures that occur
during the post-operative period which are not reoperations
or treatment for complications;
Year: 2008
Issue: April
Pages: -11
Title: Coding Consultation: Questions and Answers
Body: Surgery: Digestive System
Question: A patient presented with a clogged gastrostomy tube. After examining the existing tube site, the physician deflated the balloon. The existing gastrostomy tube was removed. A new balloon tube was tested and inserted without the use of fluoroscopic guidance. What is the appropriate code to report for this procedure?
Answer: The appropriate code to report for this procedure is code 43760, Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance.
My question is a clogged tube a complication of the original placement? We have a scenario where the patient had one placed in an open fashion, comes to the office with a clogged catheter and the provider replaces it. If this is a complication, I cannot use modifier 78 for the office replacement (place of service 11), so does a replacement then become routine post operative care and not separately billable or is modifier 79 applicable?
Does a clogged gastrostomy tube fall into the services included in the global surgery payment as per Medicare?
All additional medical or surgical services
required of the surgeon during the post-operative
period of the surgery because of complications,
which do not require additional trips to the
operating room;
Or is it
Clearly distinct surgical procedures that occur
during the post-operative period which are not reoperations
or treatment for complications;
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bruxy83@gmail.com
Contributor
I have one today where the provider is changing the GTube from a long form to a low profile for the first time. Which ICD-9 would you use for this? Its not a complication and the V44.1 my provider chose isnt considered a primary dx code.
AnnesPics
Guest
Change Gtube @ home
I have the same problem with the CPT 43760 being denied by HZN for a home visit. My Dr. was specifically called to the home for this reason. What other CPT or is there a modifier that I can use to get this covered? Any help would be greatly appreciated.
Thank you in advance!
I have the same problem with the CPT 43760 being denied by HZN for a home visit. My Dr. was specifically called to the home for this reason. What other CPT or is there a modifier that I can use to get this covered? Any help would be greatly appreciated.
Thank you in advance!