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Gastrostomy Tube Replacement


Question

What is the correct CPT code for replacement of a malfunctioning gastrostomy tube? Egd was performed with no evidence of gastrostomy tube in the stomach. The gastrostomy tube was removed from the subcutaneous tissue and a new PEG placed.

Answer

A gastrostomy tube replacement without an EGD would be coded to 43760 however, you have indicated that an EGD was performed, to determine if the tube was actually communicating with the stomach.  This makes the coding of this case a little more difficult.  Was the Endoscope used in the gastrostomy tube replacement?  If so 43246 would be the correct code assignment.  If the EGD was performed, the scope removed, and the tube replaced one would be tempted to code 43235 for the EGD and 43760 for the tube replacement but a CCI edit is received and it questionable whether it would be appropriate to report both codes, with a modifier 59 on 43760.  I believe you will need to make a decision between 43246 and 43235 without 43760.  They will both pay based on the same APC.  


Disclaimer: All articles intended for general consumption only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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