Gastroenterology Coding Alert

Question: The physician exchanged two stents in the common bile duct. Do I report one procedure or two?

Colorado Subscriber

Answer: How you report this might come down to payer policy.

Here’s why: First, it is important to understand that when the physician replaces a stent with a new one, you’ll use 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 code represents a single duct, as the descriptor indicates. Therefore, report each stent placement or exchange separately.

For example, if the gastroenterologist exchanges two stents in the common bile duct, you’ll report 43276 on the first line, then 43276 on the second line.

What will differ among payers is which modifier to report. When reporting 43276 twice, append modifiers 76 (Repeat procedure or service by same physician or other qualified health care professional), 59 (Distinct procedural service), or XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) to the second stent code, depending on the payer policy. Different payers have different preferences, so be sure to check the policy to avoid denial.