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The procedure described by CPT® Code 43246 is known as esophagogastroduodenoscopy (EGD) with directed placement of a percutaneous gastrostomy tube (PEG). This procedure is particularly indicated for patients who are unable to ingest food or liquids orally for an extended duration, often due to various medical conditions affecting swallowing or gastrointestinal function. The process begins with the administration of a local anesthetic spray to numb the mouth and throat, facilitating the insertion of a flexible fiberoptic endoscope. This endoscope is a thin, flexible tube equipped with a camera and light source, allowing for direct visualization of the esophagus, stomach, and duodenum. During the procedure, the endoscope is carefully advanced through the mouth and into the esophagus, where the physician inspects for any abnormalities. The endoscope is then further advanced into the stomach, which is inflated with air to enhance visibility. The various regions of the stomach, including the cardia, fundus, greater and lesser curvature, and antrum, are thoroughly examined. Following this, the endoscope is passed through the pylorus into the duodenum and/or jejunum for additional inspection of the mucosal surfaces. Once the endoscopic examination is complete, the PEG procedure is initiated. This involves making a small incision in the skin and upper abdominal wall, typically on the left side. A guidewire is then inserted through this incision and advanced into the gastric cavity under direct endoscopic visualization. A feeding tube is subsequently placed over the guidewire and into the stomach, after which the guidewire is removed. The feeding tube is then advanced through the stomach wall and secured in place, allowing for nutritional support to be provided directly to the stomach. This procedure is essential for patients requiring long-term enteral feeding, ensuring they receive adequate nutrition despite their inability to eat orally.
© Copyright 2025 Coding Ahead. All rights reserved.
The esophagogastroduodenoscopy with directed placement of a percutaneous gastrostomy tube (PEG) is indicated for patients who are unable to take liquids or food by mouth for an extended period of time. This inability may arise from various medical conditions, including but not limited to neurological disorders, head and neck cancers, severe swallowing difficulties (dysphagia), or other gastrointestinal issues that impair normal feeding. The procedure is essential for providing nutritional support to these patients, ensuring they receive the necessary sustenance for their health and recovery.
The procedure begins with the administration of a local anesthetic spray to numb the patient's mouth and throat, which helps to minimize discomfort during the insertion of the endoscope. Following this, a hollow mouthpiece is placed in the patient's mouth to facilitate the procedure. The physician then carefully inserts the flexible fiberoptic endoscope, which is designed to be thin and flexible, allowing it to be swallowed by the patient. As the endoscope is advanced, it passes through the cricopharyngeal region and is guided into the esophagus under direct visualization. Once in the esophagus, the physician inspects the lining for any abnormalities, such as lesions or inflammation. The endoscope is then advanced into the stomach, where air is insufflated to expand the stomach and improve visibility. The physician examines various parts of the stomach, including the cardia, fundus, greater and lesser curvature, and antrum, noting any abnormalities encountered during the inspection. After completing the examination of the stomach, the endoscope is passed through the pylorus into the duodenum and/or jejunum, allowing for further inspection of the mucosal surfaces in these areas. Once the endoscopic evaluation is complete, the PEG procedure is initiated. A small incision is made through the skin and upper abdominal wall on the left side of the abdomen. Using a push technique, a guidewire is inserted through the incision and advanced into the gastric cavity, all while being monitored through the endoscope for proper placement. A feeding tube is then advanced over the guidewire and into the stomach. After the guidewire is removed, the feeding tube is further advanced endoscopically through the mouth and into the stomach. The feeding tube is then passed through the stomach wall, and a snare is used to capture the feeding tube and pull it out through the abdominal incision. Finally, the feeding tube is secured internally with a bumper or balloon and externally with a bumper, flange, or other securing device to ensure stability and proper function.
After the completion of the esophagogastroduodenoscopy with PEG placement, patients are typically monitored for any immediate complications or adverse reactions. Post-procedure care may include instructions on how to care for the gastrostomy site to prevent infection and ensure proper healing. Patients may also receive guidance on how to use the feeding tube for nutritional intake, including the types of feedings that can be administered and the schedule for feeding. It is important for healthcare providers to assess the patient's tolerance to the feeding regimen and make adjustments as necessary. Follow-up appointments may be scheduled to evaluate the gastrostomy site and the patient's overall nutritional status, ensuring that the feeding tube remains functional and that the patient is receiving adequate nutrition.
| Short Descr | EGD PLACE GASTROSTOMY TUBE | Medium Descr | EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE | Long Descr | Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 71 - Gastrostomy, temporary and permanent |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GW | Service not related to the hospice patient's terminal condition | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | AG | Primary physician | GA | Waiver of liability statement issued as required by payer policy, individual case | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GZ | Item or service expected to be denied as not reasonable and necessary | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | A1 | Dressing for one wound | AI | Principal physician of record | AM | Physician, team member service | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | CR | Catastrophe/disaster related | ET | Emergency services | FS | Split (or shared) evaluation and management visit | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | QZ | Crna service: without medical direction by a physician | SG | Ambulatory surgical center (asc) facility service | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2014-01-01 | Changed | Description Changed |
| Pre-1990 | Added | Code added. |
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