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Gastroenterology Coding Alert

READER QUESTIONS:

Stent Is Independent of ERCP

Published on Sat Oct 08, 2005

Question: Can we report a separate procedure code to describe pancreatic stent placement and removal during ERCP for sphincterotomy?


Michigan Subscriber
Answer: Yes, you can report endoscopic insertion/removal of a tube or stent into the biliary or pancreatic duct during ERCP (43262, Endoscopic retrograde cholangiopancreatography; with sphincterotomy/papillotomy).

The appropriate code is 43268 (... with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct). CPT specifically allows you to report both procedures, instructing coders, -When [43268 is] done with sphincterotomy, also use 43262.-

Some third-party payers may allow you to report stent replacements (for instance, if an existing stent becomes occluded, and therefore the gastroenterologist must remove it and insert a new stent) using both the stent removal code 43269 (-with endoscopic retrograde removal of foreign body and/or change of tube or stent) and the stent placement 43268. Medicare and many other payers, however, always bundle the placement (43268) into the removal (43269) and will not pay for the placement separately.
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