General Surgery Coding Alert

Question: Treatment for a biliary cancer patient involved placing two separate bile-duct stents through a single percutaneous access. This was a new access. Can we bill for two stent placements?

Indiana Subscriber

Answer: You can bill for two stent placements in this case. Given that you do not mention placement of separate biliary drainage catheter, the correct code is 47539 (Placement of stent[s] into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance [e.g., fluoroscopy and/or ultrasound], balloon dilation, catheter exchange[s] and catheter removal[s] when performed, and all associated radiological supervision and interpretation, each stent; new access, without placement of separate biliary drainage catheter). 

According to CPT^® instruction, you should report this code (as well as related biliary stent and catheter placement codes) once for each stent or catheter. The instructions go on to clarify that you may report the code “more than once in the same session using modifier 59 (Distinct procedural service) for the additional procedures…” when the case involves one of the following circumstances:

• Placement of side-by-side (double-barrel) stents within a single bile duct
• Placement of two or more stents into separate bile ducts through a single percutaneous access. (This is the circumstance that matches the case you describe.)
• Placement of stents through two or more percutaneous access sites — for example, placement of one stent through the interstices of another stent.

Note: Different payers may have different billing instructions, such as billing multiple units of the code rather than billing subsequent units with modifier 59. You should follow payer instructions on this point.