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ERCP with Sludge Removal

Susan Posted Mon 01st of October, 2018 14:53:24 PM
During ERCP physician removed and replaced Stent 43246, he also swept the Biliary tree for debri and swept out sludge, using 43264.The 43264 denied as not medically necessary , the description of 43264 states Stones or Debris. In the past I have used k82.9 ,disease of gallbladder, unspecified (Sludge) that info came from a GI seminar. Tennessee is now with Palmetto were as before we had Cahaba. Please advise on 43264/k82.9
SuperCoder Answered Wed 03rd of October, 2018 06:14:04 AM

Hi Susan,

The correct code for removal and replacement of stent is 43276. According to NCCI Edits, the code combination 43276 & 43264 is reportable and there is no conflict regarding the combination. Hence, the codes are separately reimbursable. Please don’t forget to confirm the documentation for removal of debri Additionally, the code states that removal of any mineral buildups can also be reported under this code. Similarly if they do the balloon sweeps and no stones or sludge are found/removed you would still code 43264 and add the 52 modifier.

Good Day!

Further query is welcome.

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