What is the ICD 9 code for tube feeding?

In the complex world of medical coding, there is no single ICD-9 code for the broad concept of "tube feeding." Instead, a medical coder must use a combination of procedure and diagnosis codes to accurately describe the service. The specific ICD 9 code for tube feeding depends on whether you are coding for the infusion of nutrients or the insertion of the feeding tube itself.

Quick Summary

Tube feeding requires specific ICD-9 procedure codes, such as 96.6 for enteral infusion, along with relevant diagnosis codes for the patient's underlying condition. The correct codes depend on the specific method of nutritional support and the medical necessity.

Key Points

• No Single Code: There is no single ICD-9 code for the broad term "tube feeding"; a combination of procedure and diagnosis codes is required.

• Procedure Code 96.6: The specific code for the administration of nutritional substances is 96.6, "Enteral infusion of concentrated nutritional substances".

• Insertion and Management Codes: Separate procedure codes are used for tube insertion (e.g., 96.07 for NG, 43.11 for PEG) and nonoperative replacement (97.02) or removal (97.51).

• Diagnosis is Necessary: Procedure codes must be justified by diagnosis codes indicating the medical necessity, such as malnutrition (263.x) or feeding difficulties (783.3).

• Legacy System: As of October 2015, ICD-9 was replaced by ICD-10 for US billing. The ICD-9 codes are now used primarily for historical record-keeping and appeals.

• Documentation is Crucial: Accurate coding in the ICD-9 system relies on detailed clinical documentation describing the specific procedure, the reason for the feeding, and the patient's condition.

The Core ICD-9 Procedure Code for Enteral Infusion

For the actual administration of nutritional substances via a feeding tube, the primary ICD-9 procedure code to use is 96.6, which stands for "Enteral infusion of concentrated nutritional substances". This code is found in Volume 3 of the ICD-9-CM, within the category for Miscellaneous Diagnostic and Therapeutic Procedures. It is used to report the therapeutic intervention of delivering nutrients directly into the patient's gastrointestinal tract.

Importance of Correct Procedure Coding

Accurately capturing the service provided is critical for proper billing and record-keeping, especially for legacy data. Code 96.6 specifically documents the infusion of concentrated nutrition. It is important not to confuse this with the codes for inserting, replacing, or removing the physical tube, which are separate procedures.

Other Key ICD-9 Codes for Tube Feeding Management

Beyond the ongoing infusion, other procedures related to tube feeding must be coded separately. This is a key distinction from the more detailed coding systems like ICD-10.

Insertion and Placement Codes

• Insertion of a Nasogastric (NG) Tube: For a temporary feeding tube inserted through the nose into the stomach, the correct code is 96.07. The full description is "Insertion of other (naso-)gastric tube".
• Placement of a Percutaneous Endoscopic Gastrostomy (PEG) Tube: For a feeding tube surgically placed directly into the stomach, often a more permanent solution, the code is 43.11. This code is located in the operations on the digestive system chapter.

Removal and Replacement Codes

• Nonoperative Replacement of Gastrostomy Tube: When a gastrostomy tube is replaced without surgery, the code to use is 97.02.
• Nonoperative Removal of Gastrostomy Tube: The code for removing a gastrostomy tube is 97.51.

Diagnosis Codes That Justify Tube Feeding

A procedure code is rarely sufficient on its own for billing. It must be paired with one or more diagnosis codes that explain the medical necessity. For tube feeding, these often fall under nutritional deficiencies or feeding difficulties.

Common Diagnosis Categories

• Malnutrition: This is a very common reason for tube feeding. The ICD-9 system provides a range of codes for different levels and types of malnutrition.
  • 263.0: Malnutrition of moderate degree
  • 263.1: Malnutrition of mild degree
  • 263.9: Unspecified protein-calorie malnutrition
• Feeding Difficulties: Code 783.3 is used for "Feeding difficulties and mismanagement," a relevant diagnosis for patients unable to eat orally.
• Other Conditions: The underlying condition necessitating the feeding should also be coded. For example, dysphagia (difficulty swallowing) is a key indicator for tube feeding. Other reasons could include neurological disorders or post-operative care.

The Evolution from ICD-9 to ICD-10

It is essential to recognize that the ICD-9 system is a legacy system for most billing purposes in the United States, as it was replaced by ICD-10 on October 1, 2015. While ICD-9 is no longer used for new claims, understanding these codes is still important for reviewing historical patient records, managing appeals for older claims, or conducting certain types of research.

ICD-9 vs. ICD-10: How Coding Changed

The primary difference between the two systems for tube feeding is specificity. ICD-10 allows for much greater detail, distinguishing between laterality, specific body parts, and the procedural approach. For instance, ICD-10 would have distinct codes for inserting a feeding device into the stomach via a percutaneous versus open approach, a level of detail not available in ICD-9.

A Coder's Checklist for Tube Feeding

To ensure accurate coding in the ICD-9 system, coders should follow these steps:

• Verify Documentation: All services, including tube placement, infusion, and diagnosis, must be clearly documented in the patient's record.
• Identify the Service: Determine if the visit involves tube insertion, replacement, removal, or the ongoing infusion of nutrients.
• Select Procedure Code(s): Choose the appropriate Volume 3 procedure code, such as 96.6, 96.07, 43.11, 97.02, or 97.51.
• Link Diagnosis Code(s): Assign a Volume 1 diagnosis code that justifies the procedure, such as a malnutrition code (e.g., 263.9) or feeding difficulty code (783.3).
• Review for Completeness: Ensure that all necessary codes are included to tell the complete story of the patient's care. For example, if a PEG tube is placed and then feeding is initiated, both the insertion code (43.11) and the infusion code (96.6) should be considered.

Comparison Table: ICD-9 Codes for Different Tube Feeding Scenarios

Scenario	ICD-9 Procedure Code	Description
Ongoing Infusion	96.6	Enteral infusion of concentrated nutritional substances
NG Tube Insertion	96.07	Insertion of other (naso-)gastric tube
PEG Tube Insertion	43.11	Percutaneous [endoscopic] gastrostomy
Gastrostomy Tube Replacement	97.02	Nonoperative replacement of gastrostomy tube
Gastrostomy Tube Removal	97.51	Nonoperative removal of gastrostomy tube

Conclusion

The question of what is the ICD 9 code for tube feeding reveals the nuances of a retired coding system. There is no single answer, but rather a set of procedure and diagnosis codes that must be combined to accurately reflect the medical service provided. The primary procedure code for the infusion itself is 96.6, which is supported by additional codes for tube management and underlying diagnoses like malnutrition. While the ICD-9 system is no longer used for new claims, its legacy remains important for processing historical data and understanding the evolution of medical coding. The precise documentation of the entire process—from tube placement to nutritional infusion and the reason for the feeding—is paramount for correct coding. To learn more about specific ICD-9 codes, you can reference resources like AAPC's comprehensive code library 96.6 ICD-9 Vol 3 Code - AAPC.

Note: While this article provides information on ICD-9 codes, current billing and coding for new services must utilize the ICD-10 system. This article is intended for historical reference and informational purposes only.

Frequently Asked Questions

What is the primary ICD-9 code for the administration of tube feeding?

The primary ICD-9 procedure code for the infusion of nutrients via a tube is 96.6, which stands for "Enteral infusion of concentrated nutritional substances".

Does the ICD-9 code for tube feeding also include the insertion of the tube?

No, the procedure code for the infusion (96.6) is separate from the code for inserting the tube. For instance, the code for inserting a nasogastric tube is 96.07, and for a PEG tube, it is 43.11.

What kind of diagnosis codes are used with the tube feeding procedure codes?

A tube feeding procedure code must be linked to a diagnosis code that shows medical necessity. Common diagnoses include malnutrition (codes 260-263) and feeding difficulties (code 783.3).

Is ICD-9 still used for billing tube feeding in the United States?

No, ICD-9 was replaced by ICD-10 for billing new services in the U.S. as of October 2015. The codes are now used primarily for historical record review or for processing very old claims.

How do you code for the nonoperative replacement of a gastrostomy tube in ICD-9?

The ICD-9 procedure code for the nonoperative replacement of a gastrostomy tube is 97.02.

What if the tube feeding is for an unspecified nutritional deficiency?

In cases of unspecified nutritional deficiency, the ICD-9 diagnosis code 263.9, which refers to "Unspecified protein-calorie malnutrition," is often used.

How did the ICD-10 transition affect tube feeding coding?

The transition to ICD-10 introduced greater specificity, allowing coders to specify the procedural approach, laterality, and more detailed anatomical sites, which was a limitation of the simpler ICD-9 system.