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Gastroenterology Coding Alert

You Be the Coder:

Can You Remove All Doubt About This Stent Removal?

Published on Mon Mar 23, 2009

Question: My physician gave me charges for an EGD with foreign-body removal connected to diagnosis of 936. He also performed a gastric biopsy with cold forceps for acute gastritis without obstruction. In the op note, he states that the foreign body is a plastic biliary stent that was properly positioned in the papilla and that he removed it with a snare.

He wants me to use 43247 for the procedure. My dispute is that he went into the papilla to remove the stent, which I think 43269 better describes. If he had removed the stent from the stomach or any other area I would agree with 43247. What codes are appropriate for this case?

Utah Subscriber

Answer: Just code for the EGD with biopsy (43239,Upper gastrointestinal endoscopy including esophagus,stomach, and either the duodenum and/or jejunum a appropriate; with biopsy, single or multiple).

To bill ERCP with removal (43269, Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of foreign body and/or change of tube or stent) your gastroenterologist must:

• perform an ERCP including the contrast imaging of the bile duct or pancreatic duct ,and/or

• replace the stent.

He didn't do either; he just removed the stent. Code 535.00 (Acute gastritis without mention of hemorrhage) for the primary diagnosis.

The Correct Coding Initiative (CCI) stipulates,"CPT codes such as 43247 should not be reported for routine removal of previously placed therapeutic devices."

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