Gastroenterology Coding Alert

Question: Can I report 43269 twice if our gastroenterologist changed one stent in the biliary tree and one in the pancreatic duct? Also, tell me if he removed one stent in the biliary duct and placed a stent in the pancreatic duct, should I report only 43269 as this code says change of stent?

Minnesota Subscriber

Answer: Yes, you are correct in reporting 43269 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of foreign body and/or change of tube or stent)twice if your clinician performed removal and replacement of the stents from two separate ducts (biliary and pancreatic) in the same operative session. This is because he is performing the procedure in two different anatomical locations. If multiple stents are removed from the same duct, then you will be reporting the code only once.

Also, if two stents are removed and only one stent is replaced, 43269 would be reported only once.If a stent is removed from the pancreatic duct but then a stent was placed in the common bile duct, you would report 43268 (…with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct) with the modifier 59 (Distinct procedural service). Provide adequate documentation to inform the payer that the 43269 was for the procedure in the pancreatic duct and the 43268 was for the procedure in the common bile duct.

Note: If the procedure is performed after Jan.1, 2014, you cannot use the above mentioned codes to report the services as these codes are to be deleted and new codes will have to be used instead. So, if the date of service is after Jan.1, 2014, you will use 43274 (Endoscopic retrograde cholangiopancreatography [ERCP]; with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent) for the placement of a stent into the biliary or pancreatic ducts and 43275 (…with removal of foreign body[s] or stent[s] from biliary/pancreatic duct[s])for the removal of the stent(s).

When your clinician is removing the stent and replacing it in the same session, you will have to use another code to report this procedure if it is performed after Jan.1, 2014. In such a case, you will use 43276 (…with removal and exchange of stent[s], biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged) to report this.