Gastroenterology Coding Alert

Question: Our physician performed stent exchange on a patient with stricture of the biliary duct because of stent blockage. What is the correct way to code this service? Am I correct to code 576.2 as the primary ICD9 code, and 996.59 as the second? What is a biliary stent exchange?

Colorado Subscriber

Answer: You can report the stent exchange with 43276 (Endoscopic retrograde cholangiopancreatography [ERCP]; with removal and exchange of stent[s], biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged). The diagnosis codes that you have selected appear to be correct as well; however, they may not be covered by the payer for this procedure code. You should check your LCD or payer policy to determine if these codes are covered. You may be able to also query your provider for more information to determine if another diagnosis code may be more applicable.