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Otolaryngology Coding Alert

Prepare Your Practice for 5 G-Tube Changes in 2008

You-ll need a new code for through-skin placement Your gastrostomy tube coding just got much clearer thanks to CPT 2008. Make sure your placement codes get the update they need with this take-away advice. You won't have to educate staff on bread-and-butter otolaryngology surgery code changes this winter. "CPT 2008 doesn't contain any significant changes to the traditional ENT code set," says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders based in Salt Lake City. But otolaryngologists who place gastrostomy tubes "will need to update fee sheets and be sure they use the right codes," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program. Stick With 43246 for True PEG If your otolaryngologist places a true percutaneous endoscopic gastrostomy (PEG) tube, 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) should be your code of choice for now and into the next year. CPT 2008 makes no changes to this code. What to look for: The operative note for 43246 will describe an upper GI endoscopy with gastrostomy tube insertion. As the code descriptor specifies, placement of this type involves both an endoscopic and a percutaneous (through the skin) component. Generally, the tube's purpose is either to provide nutrition (a feeding tube) or to act as a drain (in place of a nasogastric tube). 1. Replace 43750 With 49440 When the physician places a gastrostomy tube percutaneously without using an endoscope, get ready to change your coding. You should now select 43750 (Percutaneous placement of gastrostomy tube). CPT 2008 deletes this code. New way: Starting Jan. 1, you-ll instead code percutaneous gastrostomy tube placement with 49440 (Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection[s], image documentation and report). Guidance provides a clue: During this procedure, the surgeon punctures the abdominal wall from outside the body and inserts a device under fluoroscopic or ultrasound guidance. This allows the surgeon to pull the stomach up to the abdominal wall and then insert the tube percutaneously without using an endoscope. During this procedure, the surgeon punctures the abdominal wall from outside the body and inserts a wire, which she pulls up through the mouth. She then attaches the tube and pulls it back through the mouth to the opening in the stomach. The surgeon does not use the endoscope but will usually use either ultrasound or fluoroscopy to help guide her. 2. Include S&I in 49440 Code 49440 puts an end to separately reporting this ultrasound [...]

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