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Tip: Understand PEG tubes

Ambulatory Surgery Reimbursement Update, May 6, 2008

The codes for percutaneous endoscopic gastrostomy (PEG) tubes or J-tubes (also referred to as “buttons”) are as follows:

• Placement procedures
  • Code 43246: Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube
  • Code 49440: Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s)
  • Code 49441: Insertion of duodenostomy or jejunostomy tube, percutaneous,  under fluoroscopic guidance  including contrast injection(s)
• Replacement procedures
  • Code 49450:   Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous,  under fluoroscopic guidance including contrast injection(s)
  • Code 43760: Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance
• Mechanical removal of tube obstructions
  • Code 49460: Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including contrast injection(s), if performed
• Tube removal
  • Code 43870: Closure of gastrostomy, surgical. Note: There MUST be stitches placed with a surgical closure to use this code. It is important to understand that if no stitches are placed and the tube is just pulled and steri-strips are put over the gastrostomy opening, coders must report code 49999, the unlisted GI code, since there is no code for that this process. Remember also that Medicare does not accept unlisted codes.

This tip is brought to you by Ellis Medical Consulting, Inc.

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