Effective October 1, 2009, a unique code has been created to identify the endoscopic insertion of a colonic stent (46.86). A colonic stent insertion via colonoscopy may be used as an alternative to emergency surgery to treat patients with acute malignant colonic obstruction. The stents can be placed radiographically (fluoroscopically), endoscopically, or with a combined technique. Over the last few years, the use of self-expandable metal stents (SEMS) for the relief of malignant or benign colonic obstruction as an alternative to bridge-to-surgery has become more acceptable. Prior to this change, insertion of colonic stent was assigned to code 46.85, Dilation of intestine.
New code 46.86 Endoscopic insertion of colonic stent(s) Colonoscopy (flexible) (through stoma) with transendoscopic stent placement Combined with fluoroscopic-guided insertion Stent endoprosthesis of colon Through the scope [TTS] technique Excludes: other nonendoscopic insertion of colonic stent (46.87) New code 46.87 Other insertion of colonic stent(s) Includes: that by: fluoroscopic guidance only rectal guiding tube Nonendoscopic insertion Code also any synchronous diagnostic procedure(s) Excludes: endoscopic insertion of colonic stent (46.86)
A patient with obstructive colon cancer was admitted for colonoscopy with colonic stenting for stricture relief. Please provide advice regarding the coding of colonic stenting. Should the colonoscopy be coded separately?
Assign code 46.86, Endoscopic insertion of colonic stent(s), for the insertion of a colonic stent. No additional code is assigned for the colonoscopy since the code title itself indicates that this is an endoscopic stent insertion.