Gastroenterology Coding Alert

Reader Questions:

See the Difference Between Coding Stent Exchanges and Removals

Published on Thu Jan 25, 2024

Question: When the provider exchanges two stents, do I report one code or two for the procedure? For example, a physician in our office recently exchanged two stents in the common bile duct. They didn’t remove any stents. Is one placement procedure appropriate, or two?

Mississippi Subscriber

Answer: If the doctor didn’t remove any stents, you’ll only report one code to represent the exchange. However, if this procedure was done twice, you’ll report that exchange code twice. In other words, if the gastroenterologist exchanges two stents in the common bile duct, report 43276 (Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent) on the first line, and 43276 on the second line.

Coding alert: This all differs, however, when the physician removes, rather than exchanges, one or more stents. You can only report 43275 (Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s)) once, even if the physician removes multiple stents.

Modifier alert: 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.

Documentation alert: Be sure to include any notes that indicate exact locations for each procedure.