Gastroenterology Coding Alert

Question: My gastroenterologist recently performed a biliary stent removal. He didn’t do anything else. They didn’t look at anything, just went in with scope and removed the stent. Could I still bill 43269 or should I use another CPT® to report the procedure that my gastroenterologist performed?

Indiana Subscriber

Answer: If your gastroenterologist performed only a stent removal from the biliary duct, you will have to report the procedure understanding the method in which the removal was performed. If your gastroenterologist performed an endoscopic retrograde cholangiopancreatography (ERCP) procedure for the removal of the stent, then you will have to report the procedure using the CPT® code 43269 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of foreign body and/or change of tube or stent).

If the procedure was done using an upper esophagealgastroduodenoscopy (EGD) using an endoscope and no ERCP was performed, then you cannot report 43269 for the procedure. An ERCP includes the insertion of a catheter into the biliary or pancreatic ducts to inject contrast for the purpose of obtaining fluoroscopic X-ray images. Where there is no attempt to perform cholangiopancreatography, you will have to report 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body) to report the biliary stent removal that your gastroenterologist performed.

Note: Support your claim with adequate physician documentation so that the payer will be aware of exactly what the procedure was and what method was used to perform the procedure. In case you are not able to identify from the procedure notes the method your gastroenterologist used to perform the procedure, check with him so that you will not make a mistake in your claims and risk denials.