We repositioned a chest tube in IR today, it was originally placed by a surgeon it was not removed. We used wires and catheters to advance the catheter into the apex. It was sutured in place. It remained on a water sealed the entire time. 32999 is my best guess, but we something for S&I.
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Tag Archives: tube
PEG Tube Q&A
type A aortic dissection repair using 30mm tube graft including hemiarch repair
Is this billed a 33860 or 33860 and 33870 59
veerbiage:
Once an adequate arrest had been obtained. the aorta was then opened transversely and was found to be dissected down just above the sinotubular junction with an obvious tear in the ascending. During this time systemic cooling was initiated. Attention was first turned to the root end of the aorta. The aorta was trimmed back to just above the sinotublular junction. the valve was resuspended with pledgeted Prolene sutures just above each commissure. The aortic layers were then reconstituted with felt outside with 3-0 Prolene in a running fashion. Around this time the physician reported that the temperature of 70 degrees Celsius had been obtained. At this point circulatory support was ceased and the aortic clamp was released. The aorta was resected back to just under the innominate. When the interior of the arch was inspected we encountered what appeared to be the start of the dissection. It was a tear between the left carotid and the left subclavian artery extending ip toward teh cranial surface of the arch. The was reapproximated with several felt pledgets including a felt strip on the outside and on the inside.
The posterior surface of the aortic arch appeared normal. At this point, the ylayers were reapproximated using a felt strip outside and running 3-0 Prolene. The aorta had been measure at the sinotubular juction and the arch. A 30mm graft was then obtained ad then anastomosed using 3-0 Prolene. As soon as the anastomosis was complete, the graft was coated with bioglue exteriorly. circulatory support was slowly support was slowly reinstituted. Attention was turned to the root end of the anastomosis. the graft was then cut to fit and anastomosed using 3-0 Prolene in a running fashion.. the initial rhythm was fibrillation which converted to sinus rhythm with single cardioversion.
EGD to insert feeding tube
doctor performed EGD for purpose of placement of feeding tube (several failed attempts at bedside). Tube was inserted thru nasal and positioned with aid of EGD into 3D. CPT code 43241? Flo guidance was not used. Report also report details condition of esophagus and stomach.
Any help will be appreciated.
Denial issues: No ROS and PEG tube placement
Good morning!
I have a claim I am struggling with.
This claim was initially billed to UHC as:
02/05/17 99223
02/06/17 99233 – 57
02/07/17 31600
02/07/17 43246 – 59
I have several issues with this claim/denial:
1. Line 02/05/17 99223 was denied for level of service. We sent the medical records, but they didn’t deem them sufficient for this level of service. I am having a hard time determining the level due to the information provided. Here is what I was given:
HPI:
The HPI that was listed on the intake form is:
67F presented to X Facility on 01/28 after found down by husband at home. She was AO with left sided weakness on arrival but progressively worsened. She became less responsive, GCS 8 and was unable to protect her airway. She was remained intubated since that time. She was found to have a ICH due to a small AVM. No neurosurgical intervention is planned at this time. Off of all sedation she is only able to follow simple commands and oopens eyes to pain. General surgery has been consulted for trach and peg.
History:
Med history: GERD, hyperlipidemia, hypertension, Osteoarthritis
Surg history: appendectomy, hysterectomy
Social history: lives with family, married
Family history: Father – Diabetes
ROS: Unable to obtain due to ventilator; ams
It also states under the Diagnosis, Assessment & Plan:
– Will plan for trach and PEG this week
– Procedure explained and all questions answered with husband and daughter
2. Line 02/06/17 99233 – 57 was denied for improper use of modifier.
The decision for surgery was made on 02/05/17 so this mod doesn’t apply. I think it needs to be removed, my co-worker disagrees.
3. Line 02/07/17 43246 – 59 was denied for Medical Record does not support code.
The lines from the Op Report that pertain to this are as follows:
The guidewire was passed. It was snared and brought out through the oropharynx with the EGD scope. A PEG was then placed through the guidewire and brought back down though the oropharynx into the stomach through the abdominal wall. It was secured at 3.5 at the skin incision and placed a 2-0 nylon the around bumper and to the skin.
Is that sufficient enough info to bill the 43246?
I know this is a lot to take in. I am new to this practice and not familiar with these types of surgeries just yet. I would appreciate any help and/or suggestions with the above listed three problems.
Chest Tube Repositioning
I am trying find the right code for a patient that had a chest tube placed, but then had to have it repositioned during the global period. Provider A originally placed the chest tube, but then provider B, from the same practice, removed and repositioned the chest tube, using the original incision. Can provider B code the removal and also the insertion if modifier 77 or 78 were added?
Here is the OP note:
POST ADMISSION PHYSICAL EVALUATION:
Patient with the dizziness increased shortness of breath and a worsening chest x-ray with accumulation of pleural effusion on the right side question of placement of previous chest tube will reevaluate and change chest tubes.
PREPROCEDURE DIAGNOSES:
Hemothorax/pleural effusion
RATIONALE FOR PROCEDURE:
Accumulation of pleural fluid with shortness of breath and increase hypotension
PROCEDURE IN DETAIL:
Under L control and sterile conditions using aseptic technique and after obtaining informed consent from patient timeout was called and #24 French chest tube was prepped and the previous chest tube was withdrawn without any difficulties. Aiming to go above the rib between the fifth and fourth space blunt dissection with finger as well as with hemostats was done until obtaining good placement. Chest tube was introduced without difficulties obtaining a spontaneous drainage of the dark blood fluid for approximately 500 cc. Chest tube was placed on Pleur-evac with suction and a total of 1000 cc were drained. No bright red blood was observed. No evidence of air leak was found. Patient was kept on Pleur-evac with suction. Chest tube was sutured in place and dressed without difficulties patient tolerated well procedure chest x-ray was reviewed next of kin was notified as well.
POSTPROCEDURE CONDITION:
Patient with O2 saturation above 100% with the 4 L nasal cannula blood pressure heart rate stable patient alert and answering questions appropriately in no distress. Chest x-ray showed chest tube in good place.
Gastrostomy Tube w/Silver Nitrate
Is there a modifier we can use so that we can bill both the G-tube change and the silver nitrate of hyper granulation tissue if performed on the same day
PEG tube replacement
Hello,
Can anybody give CPT code for PEG tube replacement done endoscopically?
Gastroenterology coding update: Ensure tube changes claim success
When your gastroenterologist deals with any of the various types of gastrointestinal (GI) tubes, you should examine how he carried out the proceudre to the patient to determine the right CPT codes.
Gastrointestinal procedures contain three main types which are initial tube placement, tube placement, and tube maintenance. Each provides a unique set of guidance that calls for a different coding approach. Follow it to a T, and you will always be safe. Here’s what our experts have to say.
Choose proper âinitial’ gastrointestinal tube placement code
If your gastroenterologist carried out an initial, percutaneous insertion of a gastrostomy tube, without using an endoscope and including radiologic supervision and interpretation, report 49440.
In this procedure, the gastroenterologist creates a puncture through the patient’s abdominal wall from outside the body, and inserts a device under fluoroscopic or ultrasound guidance. This allows the doctor to pull the stomach up to the abdominal wall and then insert the tube percutaneously without using an endoscope.
Flashback: Earlier, you would report this procedure using 43750. However in 2008, CPT deleted this code. Its replacement 49440 covers all of the components to place the tube, including the associated imaging procedures.
Watch your âmaintenance’ procedures
For maintenance services, you should familiarize yourself with another set of codes which includes 49460 and 49465.
Remember that codes 49440-49442, 49450-49452, 49460, and 49465 all include fluoroscopic guidance.
For more gastroenterology coding update, sign up for an audio conference. When you sign up for one, you’ll have access to all gastroenterology coding update under one roof. The best part of attending such an audio conference is that you can listen to it from the comforts of your own office. Even if you miss out on a scheduled gastroenterology coding conference, you can always fall back on CDs and MP3s to take you through the entire event. You even stand to acquire CEUs on attending one.
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Myringotomy tube removal and expression of pus from the same ear. HELP!!
I am very confused about a report I currently have.
My doctor performed cerumen removal on the left side. On the right side, he performed ventilating tube removal and then expressed pus from the posterior earlobe.
How would the codes look like? I am thinking either 1,2 or 3:
- 69000, 69424-59, 69210-XS
- 69000, 69210-XS
- 69424, 10060, 69210-XS
Thanks everyone!