# Need help coding ERCP Stent Exchange



## clarkmegan (May 24, 2017)

Should the appropriate codes be: 43274, 47537 or just 43276?  We did not originally place the PTC and the removal of PTC through abdominal wall is what's throwing me off.

_Indication: Known Pancreatic cancer with malignant common bile duct obstruction. ERCP for exchange of stent/internalization

Description: Scope introduced through mouth into the second portion of the duodenum and ultimately via fluoroscopy into the common bile duct. Selective biliary cannulation was used with a wire first approach with 44 cannula.  We cannulated alongside the existing PTC catheter/stent. Wire was advanced ultimately across stricture and into the proximal common bile duct.

Cholangiogram revealed an abrupt stricture about 4cm upstream from major papilla. Next, we made an 8mm sphincterotomy over the wire using Erbe blended current.

We then removed the 44 cannula and advanced a 10x60 wallstent over the wire and once this was at a satisfactory position, we removed the existing PTC by pulling this out through her right upper quadrant where it had initially been placed. Wallstent was deployed and was in outstanding fluoroscopic and endoscopic position.

Impression: 
1.Prior percutaneous transhepatic cholangiogram in place, ultimately removed
2. catheterization of common bile duct alongside prior percutaneous transhepatic cholangiogram with cholangiogram revealing distal CBD stricture
3.. billiary sphincterotomy performed
4. 10mmx60mm wallsent placed_


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## ronaldgfell (May 25, 2017)

*ERCP stent exchange*

From the notes I would code the following:

47537    1.Prior percutaneous transhepatic cholangiogram in place, ultimately removed
43276    2. catheterization of common bile duct alongside prior percutaneous transhepatic cholangiogram 
             with cholangiogram revealing distal CBD stricture
             3.. billiary sphincterotomy performed
              4. 10mmx60mm wallsent placed 


Read your book for 43276 (inclusive procedure).  Can't report 43274 with 43276

Hope that helps?


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## clarkmegan (May 26, 2017)

Thank you for your response!  Wouldn't the work for removal of PTC be included in 47537, and if I coded 43276 would that be considered double billing?  My thinking is since there are 2 different techniques, that would exclude 43276 with 47537.  The placement of the stent was via ERCP (43274) and even though there was already a catheter there, it wasn't removed via ERCP, but via percutaneous.  So that's why I was thinking 43274 and 47537 together.  What are your thoughts on that?


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## ronaldgfell (May 26, 2017)

*Follow up to your codes*

47535 does not include sphincterotomy that is why you need to use 43276 because it is removal and exchange of stent biliary or pancreatic duct, including pre and post dilation and guide wire passage, when performed including Sphincterotomy, when performed, each stent exchange.

Also and it is not double billing you would use 47537. 

those two codes cover all areas of procedure in my opinion.


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