Summary & Overview
CPT 43246: Endoscopic-Guided Percutaneous Gastrostomy Tube Placement
CPT code 43246 represents endoscopic-guided percutaneous endoscopic gastrostomy (PEG) tube placement, a common procedure to establish long-term enteral access for nutrition or decompression. Nationally, PEG placement is a frequently billed procedural category in gastroenterology and general surgery settings and has implications for inpatient and outpatient surgical throughput, device supply, and post-procedure care pathways.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of service definitions, expected sites of service, and common clinical indications for PEG placement. The publication also summarizes payer coverage considerations and typical billing modifiers used with this procedure where available.
This report provides operational benchmarks and reimbursement context relevant to hospitals, ambulatory surgery centers, and gastroenterology practices. It highlights clinical workflow points tied to device insertion, anesthesia and sedation considerations, and post-procedure monitoring. Data not available in the input are explicitly noted where relevant.
Billing Code Overview
CPT code 43246 describes endoscopic placement of a percutaneous endoscopic gastrostomy (PEG) tube. The provider inserts a flexible endoscope through the mouth and advances it into the esophagus, stomach, and duodenum to direct placement of a feeding tube through the skin and abdominal tissues into the stomach.
-
Service type: Endoscopic-guided percutaneous gastrostomy tube placement
-
Typical site of service: Hospital operating room or endoscopy suite; may also be performed in ambulatory surgery centers when appropriate
Data not available in the input for payers, taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with advanced neurologic dysphagia and recurrent aspiration is referred for endoscopic percutaneous endoscopic gastrostomy (PEG) tube placement. The patient presents to the outpatient endoscopy suite after pre-procedure evaluation by the gastroenterology team. Review of indications includes prolonged inability to maintain adequate oral intake, documented weight loss, and aspiration risk. The patient has informed consent obtained, anticoagulation reviewed and managed per protocol, and appropriate NPO status. In the procedure room the provider performs conscious sedation or monitored anesthesia care, introduces a flexible endoscope through the mouth into the esophagus, stomach, and duodenum to insufflate and identify a safe gastric site, transilluminates and externally palpates the abdominal wall, and directs percutaneous placement of the gastrostomy tube through the skin and gastric wall into the stomach under endoscopic guidance. Post-procedure care includes observation for immediate complications, confirmation of tube position, dressing application, and discharge instructions with enteral feeding initiation guidelines and follow-up arranged with nutrition and primary teams.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation/technical portion is separated and the facility bills the technical component |
50 | Bilateral procedure | Rarely applicable; used if bilateral procedures are reported and payer allows, typically not used for PEG |
51 | Multiple procedures | When additional unrelated procedures are performed during the same operative session |
52 | Reduced services | When the procedure is partially reduced or not completed as planned |
53 | Discontinued procedure | When the procedure is started but terminated due to extenuating circumstances |
59 | Distinct procedural service | To indicate a separate, distinct procedure performed on the same day when not normally bundled |
62 | Two surgeons | When two surgeons work together as primary surgeons on the same procedure |
63 | Reduced documented services for patients under 10 | When procedure is performed on a patient less than 10 years of age with reduced services documented |
76 | Repeat procedure by same physician | Use when the exact same procedure is repeated by the same physician within the postoperative period |
78 | Return to the operating room for a related procedure during the postoperative period | When an unplanned return to OR for a complication related to the original PEG occurs |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated procedure is performed during the global period |
GT | Via interactive audio and video telecommunications | When telehealth technology is used for related pre- or post-procedure visits (payer-specific acceptance) |
52 | Reduced services | When the PEG insertion is partially completed (duplicate entry retained for emphasis of clinical relevance) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207VG0200X | Gastroenterology | Primary specialty that performs endoscopic PEG placement |
2085P0206X | General Surgery | Surgeons frequently perform PEG placement, especially in complex surgical patients |
208000000X | Internal Medicine (Hospitalist) | Hospitalists coordinate inpatient indications and peri-procedural management |
2084P0800X | Thoracic Surgery | Performs placement in select patients with concurrent thoracic pathology |
207L00000X | Pulmonology | Involved when dysphagia relates to neuro-respiratory disorders and aspiration risk |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K91.2 | Esophageal and gastric anastomotic leak | Potential indication for gastrostomy management or feeding access planning in postoperative patients |
R13.10 | Dysphagia, unspecified | Common indication for long-term enteral access when oral intake is unsafe or inadequate |
K35.80 | Unspecified acute appendicitis (example placeholder) | Data not available in the input. |
G81.90 | Hemiplegia, unspecified affecting unspecified side | Neurologic impairment leading to prolonged dysphagia and need for enteral access |
Z43.1 | Encounter for attention to gastrostomy | Used for aftercare and management of gastrostomy devices |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43246 | Endoscopic placement of percutaneous gastrostomy tube (PEG) | Primary procedure: endoscopic guidance for placement of a gastrostomy tube into the stomach |
49440 | Insertion of percutaneous gastrostomy tube, under radiologic guidance | Alternate technique (radiologic) for gastrostomy insertion when endoscopic approach is contraindicated |
49441 | Replacement or change of gastrostomy tube through established stoma | Performed when the PEG tube requires exchange after initial placement |
43239 | Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum, diagnostic, with or without collection of specimen | Diagnostic endoscopy that may be performed prior to or in conjunction with PEG placement if additional evaluation is required |
31500 | Intubation, endotracheal, emergency procedure | Airway management code that may be used in case of endotracheal intubation for anesthesia or airway protection during a high-risk PEG placement |
99152 | Moderate sedation services provided by the same physician performing the procedure (initial 15 minutes) | Billed when the endoscopist provides moderate sedation services during PEG placement (payer rules vary) |