Gastroenterology Coding Alert

Question: The provider performed stone removal using lithotripsy and also removed one stent from the biliary tree. Which codes will be most appropriate to use here? What would be the most appropriate ICD-10 diagnosis code for the removal of the stent? Are Z46.59 and Z96.89 payable as primary code? Please advise.

Maine Subscriber

Answer: You may report 43265 (Endoscopic retrograde cholangiopancreatography [ERCP]; with destruction of calculi, any method [eg, mechanical, electrohydraulic, lithotripsy]) for the stone removal.

For stent removal, report 43275 (Endoscopic retrograde cholangiopancreatography [ERCP]; with removal of foreign body[s] or stent[s] from biliary/pancreatic duct[s]). You need to report 43275 once only for removal of one or more stents or foreign bodies from biliary/pancreatic duct[s] during the same session).

For removal of stent from biliary or pancreatic duct without ERCP, use 43247 (Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body[s]).

In 2017, you will also need to report the moderate sedation code separately, using 99152 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes intra-service time, patient age 5 years or older) and add-on code +99153 (…each additional 15 minutes of intra-service time [List separately in addition to code for the primary service]) depending on the duration of the service.

As for the ICD-10-CM diagnosis codes, the most appropriate ICD-10 diagnosis code for the removal of the stent will be Z46.59 (Encounter for fitting and adjustment of other gastrointestinal appliance and device).You may not choose ICD-10 Z96.89 (Presence of other specified functional implants), because Z96.89 would merely cover presence of a device rather than its removal.