Respiratory Question for the Week of January 5, 2026
Bryan Nordley
January 5, 2026
Which telehealth provisions were adopted in the Medicare Physician Fee Schedule (MPFS) final rule for CY2026?
With most bundled code sets, it’s the small details that make all the difference. Biliary procedures are much the same. The code descriptions look similar but contain subtle variations that require a good understanding of the full, long description of each code. However, code descriptions don’t always provide all the information needed for correct application and mistakes can still happen. Below are some of the common mistakes when coding biliary IR procedures and what to look for to avoid them.
Mistake 1: Unbundling
Similar to other nonvascular code sets, the codes for biliary interventions are bundled – meaning they include access, diagnostic imaging when performed at the same session, all catheter manipulations, imaging guidance and supervision and interpretation. In other words, they include just about everything that may be done to be able to place (or exchange, convert, etc.) the stent or catheter.
There are standalone codes for diagnostic cholangiography and there may be instances where the diagnostic imaging is all that is done, and these codes will be reported. However, more often than not the diagnostic imaging yields information that leads to an intervention. In these cases, reporting the diagnostic imaging separately would be unbundling.
Mistake 2: Multiple Stents
When looking at how many times a biliary stent placement code (47538-47540) may be reported, it generally comes down to the number of anatomic sites being treated. Of course, there are always exceptions, but the general rule is that the stent placement codes may be reported for each location.
47538 Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (e.g., fluoroscopy and / or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; existing access
Looking at the above code, it’s easy to think it can only be used once due to the statement “placement of stent(s).” However, the next part of that description reads “into a bile duct.” This implies that multiple stents in the same duct are only coded once, but not that stents placed in multiple ducts are only coded once. Multiple locations (i.e., stent placed in right hepatic duct and stent placed in left hepatic duct) generally means that multiple codes may be reported. Be sure to modify per payer requirements.
Mistake 3: One Stent, Two Anatomic Areas
Even though we just discussed that codes may be reported more than once for stents placed in multiple anatomic areas, there are always some exceptions to those general rules. Pay close attention to the documentation and be careful that those stents are not spanning, or overlapping, into different anatomic locations. When stents span two different locations or bridge more than one ductal segment (i.e., left hepatic duct and common bile duct), codes 47538-47540 should be reported only once.
Mistake 4: Exchanges and Conversions
An exchange refers to changing out the existing catheter for the same type of device or switching an existing internal-external catheter to an external catheter. A conversion refers to switching an existing external catheter to an internal-external catheter. If either of these types of existing catheters are switched for a completely internal drainage device, this is neither an exchange nor a conversion; this is a stent placement through an existing access.
Also note that catheter exchanges or removals performed when placing a stent are included in the stenting codes and cannot be separately reported.
For more information on exchanges and conversions CLICK HERE.
Mistake 5: Add-on Codes
For biliary interventions, add-on codes 47542 (dilation), 47543 (biopsy), and 47544 (stone removal) are reported with a primary imaging or intervention code. In order to use these codes, a primary code must be reported – even if an imaging code (47531-47532) is the primary code. A mistake people tend to make is not using the imaging code as the primary code if all that was done was a biopsy or a stone removal. There’s going to be an injection/imaging because the physician has to see where the problem is, so don’t forget that these can be used.
Which telehealth provisions were adopted in the Medicare Physician Fee Schedule (MPFS) final rule for CY2026?
Under what circumstances can code 80051 be reported multiple times?
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
