A patient of ours had an EGD performed by one physician and, at the same time, a PEG tube (percutaneous gastrostomy tube) inserted by another physician. I reported code 43246 (REVISED IN 2014), Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube, and code 43750 , Percutaneous placement of gastrostomy tube.The insurance company denied the second procedure, stating: "It is an integral part of the overall surgical procedure performed." Would you please verify for me the correct coding of these procedures? ...
Subscribe or sign in to view the full article.
Article Overview
This premium article explains a coding scenario involving endoscopic gastrointestinal evaluation and gastrostomy tube placement performed by separate physicians. It is aimed at coders and billing staff who need to understand how the procedure is categorized under CPT and why a payer may deny one of the reported services. The article provides a brief question-and-answer style discussion of the applicable procedure reporting framework.
Why This Topic Matters
Claims involving overlapping procedures and multiple physicians are a common source of denials and inconsistent reporting. Understanding the relevant CPT framework helps coders review how the service is categorized before submitting or appealing a claim.
What You Will Learn
- How the article frames a gastrostomy tube placement scenario involving more than one physician
- What general CPT guidance is discussed for endoscopic versus percutaneous tube placement
- Why payer edits may view one reported procedure as part of the overall service context
- How a coding question-and-answer format addresses the claim denial issue
Who Should Read This
- Medical coders
- Coding auditors
- Billing staff
- Revenue cycle professionals
- Physician practice managers
Codes Discussed
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com