General Surgery Coding Alert

Question: I understand that CPT® 2014 has new codes for ERCP. How should I report the service if the surgeon placed one stent in the biliary tree and one in the pancreatic duct? Also, how should we code if he removed one stent in the biliary duct and placed a stent in the pancreatic duct?

Texas Subscriber

Answer: You are correct that CPT® 2014 reworks the ERCP codes, so please be aware that the following answer applies to claims dated on or after Jan. 1, 2014.

For placing the stents in the biliary tree and the pancreatic duct, you should list two units of 43274 (Endoscopic retrograde cholangiopancreatography [ERCP]; with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent). 

Unit of service: Notice that the code definition states: “each stent.” That means you can report this code twice for your scenario, because the surgeon placed two stents at different anatomic sites.

For your second example that involves removing one stent (biliary duct) and placing a stent at a distinct site (pancreatic duct), you can report 43274 and 43275 (…with removal of foreign body[s] or stent[s] from biliary/pancreatic duct[s]). 

Same site is different: When your surgeon removes a stent and replaces it at a single site in the same session, you will have to use a different code to report this procedure. In such a case, you should use 43276 (…with removal and exchange of stent[s], biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged).