ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month ASGE gets dozens of questions from members. 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
I get confused regarding percutaneous endoscopic gastrostomy (PEG) change (with and without guidance/fluoroscopy – 43762/3), PEG removal (43247) and also NG tube placement (43241, 43752). I’m always second-guessing myself when I have to code these. Can you please explain in simpler terms for a clearer understanding of these CPT codes?
Answer #1
- 43762 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance: not requiring revision of gastrostomy tract.
- 43763 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance: requiring revision of gastrostomy tract.
- Both of these are done without endoscopic guidance.
- 43762 is just a simple removal with replacement.
- 43763 includes some type of revision such as dilation, excision of obstructive tissue in the lumen, etc.
- 43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)
- Only assigned when the removal of the tube is done endoscopically and not replaced because either the design of the tube/bumper will not allow for simple removal. CCI policy (chapter 6, section C states: 9. Intubation of the gastrointestinal tract (e.g., percutaneous placement of G-tube) includes subsequent removal of the tube. CPT codes such as 43247 (upper gastrointestinal endoscopic removal of foreign body) should not be reported for routine removal of previously placed therapeutic devices. If a previously placed therapeutic device must be removed endoscopically because it cannot be removed by a non-endoscopic procedure, a CPT code such as 43247 may be reported for the endoscopic removal.
- 43241 Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter
- This is endoscopic guidance of an NG tube which is placed by the physician from start to finish and not just to look that the tube placed by anesthesia or nurse is in good position. If done by ancillary personnel, this can’t be billed by the physician. The report needs to detail explicitly what was done by endoscopy.
- 43752 Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)
- This is non-endoscopic insertion/guidance of placement of the tube and fluoroscopy has to be utilized. This would be seldom done by our physicians.
Question #2
Can a provider’s office bill new patient or follow-up visit just for COVID testing if you never saw a provider?
Answer #2
Per the American Medical Association (AMA) release in May 2020, you can bill 99211 for a new or established patient per the AMA and CMS through the pandemic for COVID testing only. You would need the CS modifier and diagnosis of Z11.52 (encounter for screening for COVID).