2025 CPT code 43246
(Active) Effective Date: N/A Revision Date: N/A Surgery - Endoscopy Digestive System Feed
Esophagogastroduodenoscopy (EGD) with directed placement of a percutaneous gastrostomy (PEG) tube.
Modifiers may apply depending on the circumstances of the procedure (e.g., modifier 22 for increased procedural services, modifier 52 for reduced services). Consult the CPT manual and payer-specific guidelines.
Medical necessity is established based on the patient's inability to consume sufficient nutrition and hydration orally due to conditions such as dysphagia, neurological impairment, or severe gastrointestinal disorders.Documentation supporting this must be provided.
The physician's role includes administering anesthesia (if needed), inserting the endoscope, inspecting the upper GI tract, guiding the percutaneous placement of the PEG tube, making the abdominal incision, inserting the needle and wire, securing the gastrostomy tube, and ensuring appropriate aftercare.
In simple words: The doctor uses a thin, flexible tube with a camera (endoscope) to look at the food pipe (esophagus), stomach, and small intestine.During this examination, they place a feeding tube directly into the stomach through a small puncture in the belly. This tube allows for feeding when a person can't eat normally.
This CPT code represents a flexible, transoral esophagogastroduodenoscopy where the procedure includes the placement of a percutaneous gastrostomy tube.The procedure involves inserting a flexible endoscope through the mouth into the esophagus, stomach, and duodenum to visualize and guide the placement of the PEG tube through a small incision in the abdominal wall. This involves using the endoscope to guide the insertion of a needle and wire into the stomach, followed by pulling the wire through the esophagus and out of the mouth to attach a gastrostomy tube, which is then drawn back through the abdominal wall into the stomach.
Example 1: A patient with a stroke has difficulty swallowing and requires nutritional support. An EGD with PEG tube placement (43246) is performed to facilitate feeding., A patient with esophageal cancer undergoing chemotherapy experiences severe nausea and vomiting, leading to weight loss and malnutrition. A PEG tube is placed via EGD (43246) to provide nutritional support., A patient with severe neurological impairment is unable to swallow safely and requires long-term nutritional support.A PEG tube is placed via EGD (43246) to provide a safe and reliable method of feeding.
* Detailed operative note describing the endoscopy, including visualization of the esophagus, stomach, and duodenum.* Documentation of the method used for PEG tube placement, specifying the percutaneous approach.* Indication for PEG placement (e.g., dysphagia, inability to eat by mouth).* Anesthesia record (if applicable).* Post-operative instructions and follow-up plan.
** Accurate coding requires careful review of the operative report to confirm that the procedure performed matches the description of code 43246.Additional services performed during the same session may necessitate separate billing and may be subject to multiple procedure discounts. Always consult current payer guidelines to ensure compliance.
- Revenue Code: P5E (Ambulatory Procedures - Other)
- RVU: Refer to the Medicare Physician Fee Schedule (MPFS) for current RVU values and reimbursement rates.These values vary by location and payer.
- Global Days: Global period information not explicitly provided. Check payer-specific guidelines for the global period applicable to this procedure.
- Payment Status: Active
- Modifier TC rule: The TC modifier is not applicable to this procedure code.
- Fee Schedule: Historical fee schedule data is not readily available. Consult fee schedules from previous years or reimbursement databases for historical information.
- Specialties:Gastroenterology, Surgery, Oncology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center