I have not come across this before are you able to code an injection with a peg 43246? If so what CPT code would I use? Do I code EGD with Bleed as well with a Modifier?
PREOPERATIVE DIAGNOSES: Dysphagia with risk of aspiration requiring
percutaneous endoscopic gastrostomy tube insertion. The patient has been off
Plavix for 5 days with still elevated Plavix screen report as of this morning
of moderate degree.
1. Percutaneous endoscopic gastrostomy insertion without bleeding at the site of
the PEG site or internally at the PEG insertion.
2. Schatzki’s ring of mild degree in the distal esophagus. Caused some bleeding
on passing the tube requiring epinephrine injection and 1 clip at the distal
esophagus as well as application of cold water.
PREOPERATIVE MEDICATIONS: As per MAC anesthesia.
DESCRIPTION OF PROCEDURE: The patient was lying in the flat recumbent position
in the endoscopy room. After introduction of the Olympus gastroscope GIF-160
videoscope into the pharynx by, the scope was advanced into the
esophagus and easily into the stomach and subsequently into the duodenum.
Endoscopy findings show very mild degree of Schatzki’s ring at the distal
esophagus. The scope passed through it with ease. There was minimal degree of
gastritis. No polyp or ulcer was noted. The duodenum essentially was
The abdominal wall was repaired by with sterile solution. The
transilluminated light was seen in the left mid epigastric area. Local
anesthesia was infiltrated with 1% Xylocaine. Trocar needle then was inserted
through which a guidewire was advanced. The wire was retrieved using
polypectomy snare. The snare together with the wire and the scope were removed
from the stomach into the esophagus and subsequently out of the mouth.
Boston Scientific size 20-French feeding tube was inserted over the cephalic
end of the wire and was advanced into the esophagus and subsequently pulled
through a small incision that was made at the same location. The tube shows
about 3 cm mark at the skin surface. A sterile dressing was applied.
On re-endoscopy by it shows some bloody material in the distal
esophagus. On further inspection, it seems to be possibly coming from the
Schatzki’s ring upon pulling the feeding tube. Epinephrine injection was
applied then 1 endoclip was applied as well. The bleeding continued for which
a lavage with cold water was performed which seems to control the bleeding.
Upon advancing the scope into the stomach the feeding tube site was normal and
no bleeding was noted. The patient tolerated the procedure generally well.