General Surgery Coding Alert

Question: Our surgeon performed a stone removal using lithotripsy and also removed one stent from the biliary tree in the same session. Which procedure code or codes will be most appropriate for this work?

Maine Subscriber

Answer: You don’t provide enough information for a definitive answer regarding the appropriate code(s). For instance you might report a lithotripsy with various codes depending on the method and approach, such as the following:

• 43265 — Endoscopic retrograde cholangiopan­creatography (ERCP); with destruction of calculi, any method (e.g., mechanical, electrohydraulic, lithotripsy) 
• 47554 — Biliary endoscopy, percutaneous via T-tube or other tract; with removal of calculus/calculi
• +47544 — Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (e.g., mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure)

For the stent removal you might also select different codes based on the approach and method, such as the following:

• 43275 — Endoscopic retrograde cholangiopancrea­tography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) 
• 47538 or 47539 — Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangi­ography, imaging guidance (e.g., fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpre­tation … for existing or new access
• 47556 — Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent

In 2017, you will also need to report the moderate sedation code separately, if your surgeon performs that part of the procedure. Turn to 99152 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes intra-service time, patient age 5 years or older) and add-on code +99153 (…each additional 15 minutes of intra-service time [List separately in addition to code for the primary service]) depending on the duration of the service.