Gastroenterology Coding Alert

Question: If my physician places stents in both the pancreatic and bile ducts, do I only bill 43268 for this procedure?

Hawaii Subscriber

Answer: Assuming that your gastroenterologist placed these stents during an endoscopic retrograde cholangiopancreatography (ERCP), you should bill each stent separately. Append modifier 59 (Distinct procedural service) to one of the codes indicating that it is a separate and distinct procedure. So you'll report 43268 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct) and 43268-59.

Tip: If your gastroenterologist places two stents, you can make a note on your claim indicating where each stent was placed. Encourage your gastroenterologist to clearly state in his documentation the exact locations where he placed the stents.

This way, if your payer requests documentation confirming the separate procedures, the documentation will support your coding. You should also add a note stating where each stent was placed. If your gastroenterologist places two stents in the same duct, report the code only once on the claim.