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How would you code ERCP with stent replacement plus additional stent in bile duct? We understand coding of two new stents or replacement of two stents; however, the CPT book states, "Do not report 43276 in conjunction with 43262, 43274 for stent placement or exchange in same duct."

"Biliary previously placed biliary stent was extracted with a snare. Stent appeared at least partially occluded. Bile duct was deeply cannulated with a balloon and a wire. Donor native duct mismatch was again evident. Choledochocholedochal anastomotic stricture appearance is markedly improved. Bile duct was swept in the bifurcation. Debris was cleared from the bile duct. A 10 French 9 cm biliary stent was then placed across the level of the anastomosis. Subsequently a 10 French 10 cm biliary stent was deployed alongside the first stent."