# multiple stents ercp



## magmae (Apr 10, 2013)

Can anyone provide info:

Guidelines state if stenting is done in separate sites for ercp then you can bill multiple stents w/59....

Anatomy of the biliary tree includes :rt/lt hepatic ducts, common bile duct, common hepatic duct, cystic duct and intrahepatic bile ducts.

The pancreas has a main duct (The Duct of Wirsung) and an accessory duct (Duct of Santorini).

So, if dialation/stenting or anything else is done in multiple ducts are multiple codes billable?

Most seen is "biliary tree", bile ducts and pancreatic ducts...it is my thinking based on anatomy and 59 rules of "separarate sites" that separate ducts would be allowed.

Input would be appreciated.


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## bdobyns (Apr 10, 2013)

CMS Medically Unlikely Edits allow for two units of service to be billed during the same session.  

http://cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html


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## bridgettemartin (Apr 11, 2013)

When our provider places a biliary and a pancreatic stent, we bill for both, using a -59 modifier.  In Box 19, we state something like "pancreatic and biliary stents placed".


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## magmae (Apr 11, 2013)

thank you for the replies.  I get the MUE's and we also bill for the biliary and the pancreatic with a 59. 

My question is this - since anatomically the biliary has about 6 ducts and the pancreas has 2 ducts could we bill for each duct that gets stented with a 59?  The guidelines state "separate organs OR sites" and each duct is a separate site.

The MUE's state if billing additional units to use appropriate modifiers LT/RT, 59 ect...

Since most reports come thru stating stent placed in biliary duct and pancreatic duct, I am thinking that doc's are not aware if they specified which duct in each area (rt/lt hepatic, common bile duct, cystic duct etc) then they could get paid for multiple stenting...

Any ideas?


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## bridgettemartin (Apr 11, 2013)

magmae said:


> thank you for the replies.  I get the MUE's and we also bill for the biliary and the pancreatic with a 59.
> 
> My question is this - since anatomically the biliary has about 6 ducts and the pancreas has 2 ducts could we bill for each duct that gets stented with a 59?  The guidelines state "separate organs OR sites" and each duct is a separate site.
> 
> ...



I don't recall if I have come across that particular scenario, but one could argue separate ducts = separate procedure.  Now I have had a scenario where the Dr placed two stents in the same duct.  I only billed for one stent in that scenario.


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