Gastroenterology Coding Alert

Question: We received a case a few days in which the GI placed a duodenal stent during endoscopy. How should I code for such a scenario? What codes are available for transendoscopic stent placements?

Wisconsin Subscriber

Answer: Stents are inserted endoscopically and used to holdopen the lumen of the GI tract at the location it is released. n. Commonly, stents are used to preserve the esophageal lumen in cases of inoperable cancer. They also are used in other parts of the gastrointestinal system such as the colon and the duodenum. CPT^® has provided specific codes for the placement of stents in all these areas.

The placement of a duodenal stent through an upper gastrointestinal endoscopy (EGD) can be coded either through code 43266 (Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent [includes pre- and post-dilation and guide wire passage, when performed]).

You also have a dedicated stent placement code in case of esophagoscopy. You should report code 43212 (Esophagoscopy, flexible, transoral; with placement of endoscopic stent [includes pre- and post-dilation and guide wire passage, when performed]).

Similarly, for a colon stent placement, you should use codes 45327 (Proctosigmoidoscopy, rigid; with transendoscopic stent placement [includes predilation]), 45347 (Sigmoidoscopy, flexible; with placement of endoscopic stent [includes pre- and post-dilation and guide wire passage, when performed]), or 45389 (Colonoscopy, flexible; with endoscopic stent placement [includes pre- and post-dilation and guide wire passage, when performed]).

Before the provision of these codes, stent placement could be coded only through base endoscopy codes with modifier 22 (Increased procedural services) and a code for an unlisted procedure of the esophagus (such as 43499) can in addition to the base code, along with a report describing the stent placement procedure.