Question: Our physician performed an ERCP to facilitate obtaining a retrograde cholangiogram. He then removed the stent. Should I bill for the stent placement or removal, or simply charge for the ERCP?
South Dakota Subscriber
Answer: If the stent was already in place when the procedure began, you would be safe to use 43269 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of foreign body and/or change of tube or stent: APC 00384). On the other hand, if the physician placed the stent during the procedure, you should report 43268 (… with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct: APC 00384) even if he removed the stent at the end of the procedure.
Keep in mind: The Correct Coding Initiative (CCI) lists the stent placement and removal codes as mutually exclusive, which means they cannot be "reasonably done in the same session." The edit contains a modifier indicator of "1," which means you can override this edit with a modifier and differentiate between the services provided. But this only allows for physicians to receive reimbursement for stents placed and removed in different ducts, and is not intended for when the physician removes and replaces a stent in the same duct.
You cannot code separately for the cholangiogram, which is a form of visualization during which the physician injects contrast material into the bile ducts to see if any stones are present after an extraction. This, along with other visualization techniques, is an integral part of an ERCP and is not separately billable.
