PEG removal ONLY done Outpatient Hospital

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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.
 

agibb1022

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I'm interested in this too. I have always been told that we can not bill for simply removing the PEG, whether it's done bedside or with EGD. I'm anxious to see other thoughts.
 

pamsbill

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If it was removed manually (bedside), without an EGD, it is included in the E&M service for that date.

I would have to see the op note if it was done via EGD.
 

pamsbill

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One more thing:

"** 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."

I would think the docs need to document something. Even if they document the patient is post CVA, has been progressing slowly but is now eating soft foods, is swallowing fine. G-Tube is intact and appears in the RUQ, blah, blah, blah (I am making it up, so don't be hard on me - I am not a doctor!) you should be able to get a low level visit out of it. If they didn't, then they need to be educated to document better.
 
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peg tube removal at asc

Hello,

I have the same issue-
g-tube removal, outpatient in ASC, no anesthesia. I'm pretty sure we still use either the 99213 or 99214 code, but is a modifier -25 needed since it's done at the ASC? Will an E&M code go through if billed by the ASC?

please assist.
pearl
 

ReignRuby

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Good Afternoon Pearl,

I have the same situation as you have noted above in an ASC. Were you able to receive any re-imbursement? Did you end up using CPT 99213? Any help would be appreciated.
 
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Would it be appropriate to use the unlisted CPT code 43999(unlisted procedure, stomach)? Again, this is done in a outpatient ASC, no anesthesia and the provider simply removed with a single pull.
 

thomas7331

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Would it be appropriate to use the unlisted CPT code 43999(unlisted procedure, stomach)? Again, this is done in a outpatient ASC, no anesthesia and the provider simply removed with a single pull.
Non-incisional removal of a catheter, tube or drain is not considered a surgical procedure and all the guidance I have seen instructs that this is inclusive to E&M services. I think this is pretty much industry-standard these days and a payer would likely consider it inappropriate to code this as an unlisted surgical procedure.
 
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