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Seems like A LOT of controversy over which path is appropriate to coding the removal of PEG tube in tact, without complication. Below is my example, please leave your professional opinion on the appropriate path to code such an encounter/procedure.
Thank you in advance!!
I need help coding/billing for a PEG removal by EGD.
Patient was finally swallowing on their own and requested the PEG be removed. Procedure was done outpatient hospital. PEG was in tact during removal, procedure went well, patient handled it well. Also note, our DR did NOT close the gastronomy, rather he put a bandage over it. Procedure was to the point, no complications whatsoever.
-- It's not 43246, because PEG was not placed, only removed.
-- It's not 43247, because the PEG was in tact. This code would be used if the PEG had been broken or damage was the reason for removal.
-- It's not 43760, because it was done endoscopic ally, not percutaneous.
-- It's not 43870, because gastronomy was not closed.
-- By reporting the generic 43235, I would need to append a modifier 52 (reduced or eliminated procedure) due to the duodenum not being entered. I would also need to provide the op note, which could very well cause the claim to be denied due to the direct reason for the procedure was for the removal of PEG.
** Note: Most coding assistance from sites and other coders are suggesting we would only bill for the OP E&M visit. However, even that does not seem appropriate. Coding a 99213 in my opinion would just be a guesstimate, as we didn't review multiple systems, etc., we simply went in for a specific reason w/o complication.
Could anyone advise on the proper coding for such a procedure, or IF we can even code it?? ... I would think it's a shame if we couldn't bill for ANY service!
Please and thank you.
Thank you in advance!!
I need help coding/billing for a PEG removal by EGD.
Patient was finally swallowing on their own and requested the PEG be removed. Procedure was done outpatient hospital. PEG was in tact during removal, procedure went well, patient handled it well. Also note, our DR did NOT close the gastronomy, rather he put a bandage over it. Procedure was to the point, no complications whatsoever.
-- It's not 43246, because PEG was not placed, only removed.
-- It's not 43247, because the PEG was in tact. This code would be used if the PEG had been broken or damage was the reason for removal.
-- It's not 43760, because it was done endoscopic ally, not percutaneous.
-- It's not 43870, because gastronomy was not closed.
-- By reporting the generic 43235, I would need to append a modifier 52 (reduced or eliminated procedure) due to the duodenum not being entered. I would also need to provide the op note, which could very well cause the claim to be denied due to the direct reason for the procedure was for the removal of PEG.
** Note: Most coding assistance from sites and other coders are suggesting we would only bill for the OP E&M visit. However, even that does not seem appropriate. Coding a 99213 in my opinion would just be a guesstimate, as we didn't review multiple systems, etc., we simply went in for a specific reason w/o complication.
Could anyone advise on the proper coding for such a procedure, or IF we can even code it?? ... I would think it's a shame if we couldn't bill for ANY service!
Please and thank you.