Gastroenterology Coding Alert

Question: One of our doctors performed an ERCP with sphincterotomy, during which she had to facilitate cannulation of the common bile duct by placing a pancreatic stent. After the ERCP, she removed the pancreatic stent. How should I code this?

Georgia Subscriber Answer: For the ERCP, report 43262 (Endoscopic retrograde cholangiopancreatography; with sphincterotomy/papillotomy). You should code the stent placement 43268 (... with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct).
 
Since the procedures are so similar, coders may be inclined to report just one of the ERCPs and append modifier -22 (Unusual procedural services) and an explanation of the extra work involved.
 
But, as parenthetically noted in CPT's entry for 43268, "When done with sphincterotomy, also use 43262." In fact, all of these ERCP codes are to be reported separately when performed with a sphincterotomy:

 43264 - ... with endoscopic retrograde removal of calculus/calculi from biliary and/or pancreatic ducts
 43265 - ... with endoscopic retrograde destruction, lithotripsy of calculus/calculi, any method
 43267 - ... with endoscopic retrograde insertion of nasobiliary or nasopancreatic drainage tube
 43269 - ... with endoscopic retrograde removal of foreign body and/or change of tube or stent
 43271 - ... with endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic duct(s).