ERCP with Stent exchange; and additional stent placement


Columbus, Ohi
Best answers
I am looking for clear cut documentation to support coding the following service:

A 10FX5cm double pigtail stent was removed via snare. The CBD was cannulated. Retrograde opacification reveals a high grade stricture...A 10FX5cm double pigtail stent was inserted. There was immediate drainage of all contrast from the CBD. To ensure the alleviation of the stricture; a second 7FX5cm double pigtail stent was inserted; the final result being side by side stent placement.

I know the stent exchange will be billed using 43276; what I am questioning is the additional placement of the second stent.

CPT states 43274 may be billed twice for side by side stents in the same duct.
However 43276 says not to report 43276 with 43274 for exchange/placement in the same duct. But I cannot decide if they are referencing the initial stent...or if this addresses an additional stent.

So I am torn between coding this as 43276
Or 43276 and 43274,59.

Any advice or references that can assist with this scenario?