ASGE members may submit coding inquiries electronically to codingquestions@ASGE.org. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
If a peg tube were removed due to a malfunction and a new one was placed, would I use CPT code 43246 (EGD with PEG insertion) and 43247 (EGD with foreign body removal) or just 43246?
Answer
If you are removing and replacing the PEG via endoscopy, use code CPT 43246 only and note in box 19 of the claim form "Endoscopic PEG tube removal and replacement." If the replacement was not done endoscopically, then CPT code 43762 would be appropriate.
Question #2
If a provider is seeing a patient with a new diagnosis of anemia and the provider orders an EGD to rule out peptic ulcer disease (PUD), is "rule out PUD" considered an increased risk factor? Also, if a comorbidity such as hypertension or asthma is listed in the patient's problem list but not addressed in the history of present illness or the assessment and plan, does it count as an increased risk factor if the provider doesn't specifically document it?
Answer
The provider ruling out PUD is part of the thought process of the presenting problem. Consider the anemia an "undiagnosed problem w/ uncertain prognosis" since there is a workup ordered and the provider documents differential diagnosis. Comorbidities would be counted toward the level of risk, but those conditions must be documented in the plan of care and not just noted in the problem list or history.