Gastroenterology Coding Alert

Question: Our gastroenterologist recently performed a successful deployment of two fully-covered wallflexes across an esophagogastric fistula at the superior margin of the gastric sleeve. What CPT^® code should I use to report the procedure that my gastroenterologist performed?

Houston Subscriber

Answer: In the procedure that you have described, a covered wallflex refers to a specific type of stent that your gastroenterologist would have placed endoscopically during an upper EGD. The appropriate CPT^® code that you will have to report to describe the procedure performed by your gastroenterologist is 43256 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement [includes predilation]).

If you look at the descriptor for 43256, you will notice that you will have to report this code for the placement of a single stent. Since your gastroenterologist placed two stents in the same session, you will have to report two units of 43256.

Note: Any dilation that your gastroenterologist performed prior to placement of the stent should not be report separately using a separate CPT^® code. If you look at the descriptor to 43256, you will notice that this includes any sort of dilation that your gastroenterologist performed before inserting the stent.