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Removal of Gastrostomy Tube

  1. #1
    Default Removal of Gastrostomy Tube
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    The GI physician removed G-Tubes on 2 patients no EGD or anything just the removal of the tube. I know there is not a code for this procedure, but everything I have read states that it is included in the E/M. Since it is in an ASC could we bill anything for this? Thank You

  2. Default
    it depends on your contract with the insurance for the two patients the physician did this for.
    Medicare will not allow E/M codes at an asc such as 99214.

    most insurances will follow this criteria. however, i have some contracts that if the code that was performed is not on their list of payable codes for an asc, then we get reimbursed at 40% of billed amount up to a maximum payable.
    it would be best for you to talk to the person at your facility who maintains your contracts and ask him/her to get the OPG lists for each individual commercial insurance. Then talk to your contractor and understand how your contracts will pay you if a code is not on that list.

    hope this helps
    caprice w. cpc

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