# ERCP no pancreatogram, does this need a modifer?



## blathrop19@gmail.com (May 9, 2011)

Hey all,

It is kind of in the Title, but some of my docs regularly don't do a pancreatogram with their ERCP when it is for gallstones or sludge in the CBD. I have used a -52 modifier but I'm not sure if that is needed. I'm assuming it is since in the procedure it doesn't say and/or pancreatogram it just says and pancreatogram. I've looked around online and haven't found too much on this. Any help would be appreciated.

Thanks,

Bob


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## Kisalyn (May 9, 2011)

Our physicians sometimes don't do a pancreatogram either. Typically, they're visuallizing the common bile duct to remove stones and therefore, only inject in the CBD. We don't append a modifier. However, if the doctor intended to visuallize the pancreatic duct and had problems, you would append a modifier 52.

If you're subscribed to Coding Alert, they address this in their 2008 Vol 10 No 4 issue.

Hope that helps.


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## blathrop19@gmail.com (May 9, 2011)

That does help thank you. That's pretty much the same situation I am having where the doctor didn't intend to visualize the pancreatic duct.


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## russmam (Jun 21, 2011)

*Pancreatogram*

If the bile duct and/or pancreatic duct are cannulated, you may use the pancreatogram code of 43273... see below

+ 43273 Endoscopic cannulation of papilla with direct visualization of common bile duct(s) and/or pancreatic duct(s) (List separately in addition to code(s) for primary procedure)
(Use 43273 in conjunction with 43260, 43261, 43263-43265, 43267-43272)
This procedure is performed in conjunction with ERCP procedure(s). Code 43273 is the first GI endoscopy code to have an “add on” structure. This means that code +43273 must be reported in conjunction with other ERCP codes (43260, 43261, 43263-43265, 43267-43272). Because it is an add-on code, its value is not reduced by the multiple surgical services or multiple endoscopy service rules.

Code +43273 is reported only once, whether the bile duct(s) and/or pancreatic duct are examined. Note that the code is always reported in conjunction with one or more ERCP procedure codes. The most common clinical scenarios are biopsy, stent or other therapeutic procedures that are performed via ERCP during the same session as cholangioscopy/pancreatoscopy; these would then be the basic ERCP code(s) to report.

For CPT 2009, if an ERCP is performed with sphincterotomy and then direct cholangioscopy is performed, one can either report 43260 and 43273 or report 43260 with a modifier 22 Increased Procedural Services to reflect the “highly unusual work” beyond the usual work of 43260.

CMS has valued code 43273 code at 2.24 Work RVUs (Relative Value Units). The 2009 Medicare national fee schedule payment for this service is $125.51 when performed in the facility setting.

Mary Jo Russman, CPC, CGIC
Cleveland Clinic Digestive Disease Institute


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## jojogi (Jun 22, 2011)

It is my understanding that in order to use the add-on code +43273 you would have to use SpyGlass Direct Visualization equipment.  Since the ERCP includes the pancreatic duct I would put the modifier 52 to show that the services were reduced.  If anyone has heard differently, please let me know where to find the information.  Thanks.


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