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43241 Denial??

Dawna Posted Fri 25th of January, 2013 19:53:01 PM

Please review the following operative report:

Procedure: Upper GI Endoscopy

Indications: Patient with chronic pancreatitis and ongoing abd pain and failure to maintain PO nutrition. Patient requested feeding tube be placed with MAC sedation with endoscopy.

The endoscope was introduced through the mouth and advanced to the second part of the duodenum.

Findings: Naso-jejunal feeding tube was nt available, so a Dobhoff feeding tube was placed under endoscopic vision in the stomach for PO feeds.

Impression: Dobhoff tube placement

We coded this procedure: Diagnoses 783.3, 789.09, 577.1
CPT code 43241

Medicare reduced pymt stating "Allowed amout reduced-Component of basic procedure paid"

Was the procedure mis-coded? How should it have been coded?


SuperCoder Answered Mon 28th of January, 2013 20:29:34 PM

When your gastroenterologist places a naso-gastric tube during an EGD procedure, you will have to report this procedure with 43241 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic intraluminal tube or catheter placement). Many coders are confused about using 43241 for placement of a naso-gastric tube, as the insertion of the tube occurs through the nose. However, the EGD procedure your gastroenterologist conducts along with the tube placement is an aid to position the tube in the stomach. So, even though the placement of the tube occurs through the nose, you need to report 43241, as your gastroenterologist performed the EGD for the correct placement of the tube.

As far I see, you have done the correct coding.But check there is a possibility that “Medicare has reduced payment for this service because part of this service was paid on another claim. You are not responsible for the amount above the approved amount." If this is not the case,you should re appeal the case with codes.

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