by Robert Gold, MD
Every so often, I come across some coding issues that recall other coding issues. Selection of the proper procedure code can sometimes get one into trouble.
For example, there is a new code for the conversion of a percutaneous endoscopic gastrostomy (PEG) feeding tube to a transgastric percutaneous endoscopic jejunostomy (PEJ) feeding tube. It had been, prior to October 1, 2008, that this description led to the assignment of an ICD-9-CM procedure code which made the procedure a major operating room procedure and led to the 981, 982, and 983 DRGs (formerly 468).
Now, with the recognition that an anastomosis must be done endoscopically to justify a major operating room procedure, the code for the conversion of a PEG to a PEJ is no longer a procedure that affects DRG assignment.
So, be sure to read the operative note. If an anastomosis is done, then ICD-9-CM code 44.32 is justified and the procedure code affects the DRG. But, even if the physician uses the phrase or abbreviation inappropriately for conversion of a PEG to a PEJ and calls it a PEGJ when no anastomosis was done, 46.32, a non-operating room procedure is warranted, and it would not affect the DRG assignment.
You have to consider truth, justice and the American way, and assign codes properly and according to the rules, even though there may be a financial incentive to “misinterpret” for the benefit of the bottom line. And that’s where folks get into trouble.
