Gastroenterology Coding Alert

Question: am new to ERCP coding and trying to figure out how to code this scenario: ERCP with stent in biliary and pancreatic ducts (43268 and 43268-59) and then they placed a nasal enteric tube into the duodenum before they removed the endoscope. How should I code for the enteric tube placement? The physician's report says: "We then removed the cannulation apparatus from the pancreatic duct, leaving simply the stent behind. We then passed a Wilson Cook 10-French nasal enteric tube through the endoscope into what appeared to be the fourth portion of the duodenum and removed the endoscope over the nasal enteric tube. This was then transition through the patient's nose with the use of a Silastic tube and the nasal enteric tube affixed to the patient's nose at approximately 103 cm."

New Jersey Subscriber

Answer: Although your question doesn't say so, gastroenterologists usually perform additional work before they can place stents in the biliary or pancreatic ducts. In most cases, the physician will perform a sphincterotomy/papillotomy to access the ducts. You should check the procedure report for a description of that maneuver and then look up CPT

43262 (Endoscopic retrograde cholangiopancreatography [ERCP]; with sphincterotomy, papillotomy).

However, based on the description provided the service does not include a sphincterotomy/papillotomy so you should code the procedure using the following:

• 43268 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct) for the stent placed in the bile duct;
• 43268-59 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct) for the stent placed in the pancreatic duct because this code only describes the work for a single stent;
• 43241 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic intraluminal tube or catheter placement) for the nasal enteric tube placed into the duodenum.