Gastroenterology Coding Alert

Question: What code should we use for an EGD duodenal stent?

Lori Salmon
Gastroenterology Associates, Green Bay, WI

Answer: Stents are inserted endoscopically and used to hold surgical grafts in place. Commonly, stents are used to preserve the esophageal lumen in cases of inoperable cancer. They also are used in other parts of the gastrointestinal system such as the colon and the duodenum; however, there are no specific CPT codes for the placement of stents in these two areas.

The placement of a duodenal stent through an upper gastrointestinal endoscopy (EGD) can be coded either as an EGD (43235, upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) with modifier -22 (unusual procedural services) attached or as an unlisted procedure of the esophagus (43499), according to Pat Stout CMT, CPC, a gastroenterology coding consultant to the American College of Gastroenterologists. The operative report should be included in the claim, along with a report describing the stent placement procedure.

Or the code for an unlisted procedure of the esophagus (43499) can be used in addition to the base code (43235) for the EGD, says Stout. The EGD code should be listed first, followed by the unlisted procedure code. The operative report must be included in the claim, along with a report describing the stent placement procedure.

The placement of a stent in the colon can be coded in a similar fashion either by attaching modifier -22 to the base colonoscopy code (45378) or by using the unlisted procedure code for the intestine (44799) in addition to the base colonoscopy code. Again, the operative report must be included in the claim, along with a report describing the stent placement procedure.