Wiki Peg Tube change when patient supplies Peg Tube 43762 Reduced charge?

[tmoss]

Have a patient that supplies his/her own peg tubes. Patient is doing this as one they had had to be replaced within a week due to mechanical breakdown of the peg tube ( not our office). I am thinking this fee needs to be reduced as well as billing with modifier 52. Does anyone out there have a similar situation? If so how do you bill? CPT is 43762.
Thank you, Tammie

 

[haraml7]

I would not reduce the fee, because the procedure being billed is the full procedure. The provider performing the procedure should get paid for the full procedure. If this procedure is performed in a hospital you would use the hospitals PEG tube and the hospital would bill for the Tube because its their equipment. However, in this case the facility would not bill separately for the "supplies" used due to the patient has brought their own.

This is different from a patient bringing in their own medication, you would not charge the patient for the medication because normally your office supplies the medication and you would only bill the patient for the stick since you did not supply the patient with the medication you own.

So, CPT codes are based on the procedure performed not the supplies.