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Eleen Posted Tue 11th of October, 2016 10:08:29 AM
The middle third of the main bile duct contained a single severe stenosis 10 mm in length. The lower third main bileduct, upper third of the main bile duct, hepatic duct bifurcation, left main hepatic duct and right main hepatic duct were moderately dilated. The lasrgest diameter was 16mm. There was brisk drainage of the pancreatic duct and selective cannulation of pancreatic duct was not possible. A long 0.035 inch Soft Jagwire passed successfully into the left main Hepatic duct. a 3mm biliary sphincterotomy was made with a monofilament Autotome sphincterotome using ERBE electrocautery. To discover objects, the biliary tree was swept with an 11.5 mm balloon starting at bifurcation. Sludge was swept from the duct. One 10 mm by 8cm covered metal stent was placed in the common bile duct. The stent was in good position.43274 and 43262 cannot be billed together when done in the same location. Based on this report, can we bill 43274-stent placement with 43262-sphincterotomy? Stent was placed in the Common bile duct, but I am unclear on the location for the Sphincterotomy. Thank you
SuperCoder Answered Wed 12th of October, 2016 03:34:33 AM

You can't bill a stent placement code with a sphincterotomy code, when performed in the same duct. In this case, CPT code 43262 would be considered part of the CPT code 43274. Please verify from the operative report. If the ducts are different, then you can bill both CPT codes together. The bundling can be ruled out by adding XS modifier to CPT code 43262.


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