Gastroenterology Coding Alert

Question: My gastroenterologist performed a pancreatic stent placement during an ERCP with sphincterotomy. Can I report two codes for these procedures?

Tennessee Subscriber

Answer: Yes. In this case, you can report 43268 (Endoscopic retrograde cholangiopancreatography; with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct) for the stent placement. Additionally, you can report 43262 (Endoscopic retrograde cholangiopancreatography; with sphincterotomy/papillotomy) for the endoscopic retrograde cholangiopancreatography (ERCP). You do not need to attach any modifiers since CPT specifically allows you to report both procedures.

Watch out: Payers always bundle the stent placement 43268 into the stent removal 43269 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of foreign body and/or change of tube or stent) and will not pay separately for the removal. The code descriptor for 43269 specifically states "change of stent" so this includes 43269.