Clarification on appropriate diagnosis code for PEG tube malposition with vomiting
Clinical Scenario:
A patient presents with vomiting due to a malpositioned gastrojejunostomy (GJ) tube, as documented in both the interventional radiology (IR) note and physician progress note. The tube required exchange due to malposition. There is no documentation of obstruction or complication at the external gastrostomy (PEG) site. The vomiting is clinically linked to the internal displacement of the tube from a query response.
Coding Dilemma:
Given this documentation, which diagnosis code is most appropriate?
- T85.628A – Displacement of other gastroenterostomy tube, initial encounter
OR
- K94.23 – Gastrostomy complication, obstruction
These were my current references:
- ICD-10-CM Official Guidelines for Coding and Reporting (Section I.C.19.g):
• T85 codes are intended for use when complications of internal prosthetic devices are clearly documented.
- Medicare Benefit Policy Manual (Chapter 15, Section 120):
• Identifies PEG and GJ feeding tubes as prosthetic devices under Medicare policy.
- AHA Coding Clinic for ICD-10-CM, Q1 2019, p. 6:
• Advises K94.23 for GJ tube obstruction, though the rationale in that case was a clogged tube rather than a mechanical displacement.
My request for clarification is that:
Given that the PEG/GJ tube is:
- Internally placed (prosthetic), and
- Malpositioned (mechanical issue), and
- The vomiting is directly related to the tube displacement (not due to obstruction at the stoma),
What should be the principal diagnosis on this case: T85.628A rather than K94.23?
I appreciate your expertise and guidance on this proper coding assignment.
Thank you!!