Plus, find out how coding for stent placement,
removal, or both via ERCP have become simpler, thanks to CPT 2014.
The confusion over whether
your general surgeon is limited to performing services from certain sections of
CPT® or if other providers can venture into “your” territory was
always there; but CPT® 2014 clarifies all that.
Look up new introduction in CPT® 2014
New
introduction in CPT® 2014 mentions that healthcare techniques
and procedure have evolved in a way that questions the conventional distinction
of surgery versus medicine.
Therefore, the listing of a service or procedure in a specific section of this
book should not be interpreted as strictly classifying the service or procedure
as ‘surgery’ or ‘not surgery’, mentions the new CPT® 2014 introduction.
CPT® 2014 also makes coding for Stenting Procedures simpler
2014 CPT® clarifies coding for stent placement, removal or both endoscopic
retrograde cholangiopancreatography (ERCP) by introducing three new comprehensive
CPT® 2014 codes and deleting two codes that you used previously.
Here
are some tips on how you should use these changes and make your reporting of
these general surgery procedures simpler.
Strike
off these old codes
Prior to January 1,
2014, you used these two codes for reporting ERCP stent
placement/removal which have been replaced by three new codes:
·
43268 — Endoscopic retrograde cholangiopancreatography (ERCP); with
endoscopic retrograde insertion of tube or stent into bile or pancreatic duct
·
43269 — … with
endoscopic retrograde removal of foreign body and/or change of tube or stent.
Learn the new codes
Start learning and using these CPT 2014 codes:
·
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
·
Notice the new text note that directs you to 43274 for
naso-biliary or naso-pancreatic drainage tube placement instead of deleted code
43267.
·
43275 — … with removal of
foreign body(s) or stent(s) from biliary/pancreatic duct(s)
·
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.
Remember: List 43274 for each stent, even if
they are in the same duct. This is different from the old codes. Use modifier 59
(Distinct procedural service) for each subsequent stent placed.
Likewise, 43276 includes removal and
replacement of one stent.
Omission: 43275 represents removal of
one or more stents during the same operative session.
Benefits of new codes
The deleted codes did not provide a way
to differentiate the service of simply removing a stent versus removing and
replacing a stent. However, the three new codes allow you to distinguish
between the two. These codes will help you avoid confusion over picking one
code for replacement or two codes (one for the removal and the other for
insertion).
Know what’s included
Definitions suggest that the new codes 43274 and 43276 are
comprehensive and include pre- and post-dilation, guide wire passage, and
sphincterotomy, when performed. Even then, see to it that you still separately
report radiology for these services. Earlier you used to report comprehensive
ERCP stent placement service with code 43268 for the stent, 43262 for the sphincterotomy, and 43271 for the dilation.
Now you can report the same service using 43274.
ERCP codes must be used only “if one or more of the ductal
system(s) (pancreatic, biliary) is/are visualized.
Keep a general surgery
coding resource handy
