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Thread: G Tube replacement

  1. #1

    Default G Tube replacement

    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?

  2. #2

    Default

    I have always used the v55.1. A mechanical complication would be if the G tube itself has a problem. In this case the patient is the problem.

  3. #3
    Join Date
    Apr 2007
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    International Member
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    Default

    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.
    Last edited by vj_tiwari; 06-20-2010 at 11:48 PM.

  4. #4

    Default

    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-G...-Complications

  5. #5

    Default 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.

  6. #6

    Default

    We have always used 43760 and 536.49.
    Melissa Sheard, CPC

  7. #7
    Join Date
    Apr 2007
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    Evansville, Indiana
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    267

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    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.
    Bridgette Martin LPN, CPC, CEMC, CGIC

  8. #8
    Join Date
    Apr 2007
    Location
    Columbia, MO
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    11,902

    Default

    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 by mitchellde; 02-03-2014 at 06:06 AM.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9

    Default

    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.

  10. #10
    Join Date
    Apr 2007
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    Oak Ridge
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    14

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    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;
    Last edited by acf7575; 02-19-2014 at 09:56 AM. Reason: Adding information

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