Gastroenterology Coding Alert

"Gastroenterologists often fail to report all the services performed while extracting stones during an endoscopic retrograde cholangiopancreatography (ERCP). They mistakenly believe that these services are bundled by the national Correct Coding Initiative or are considered integral parts of the extraction and cannot be separately reported. Its not difficult to understand the confusion because there are some services, such as fluoroscopy or cholangiograms, that are considered standard components of ERCP and cannot be billed separately.

Report 43264 for Stone Removal

An ERCP is performed to extract stones that have lodged in the bile or pancreatic ducts. Code 43264 ERCP; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure] with endoscopic retrograde removal of stone[s] from biliary and/or pancreatic ducts) is used to report the removal of stones. Two commonly used devices for stone removal are a basket and a balloon, according to Anil Minocha, MD, FACP, FACG, chief of gastroenterology at the Southern Illinois School of Medicine and the author of 2000 Minochas Guide to Digestive Disease.

A catheter with a basket is passed over a guide wire into the duct and the basket traps the stone, which is then withdrawn into the duodenum and let loose, explains Minocha. A balloon also can be used to drag out the stones.

You should report the code once, says Sandi Scott, CPC, CORT, president of the AAPC South Beach chapter, and director of coding at the Mission Internal Medicine Group in Mission Viejo, Calif. The CPT definition of 43264 says, stone(s), so it doesnt matter about the number of stones removed or the number of methods used.

Balloon Dilation of Ducts Billed as a Separate Procedure

The use of a balloon to remove stones should not be confused with the balloon dilation of the ampulla, biliary or pancreatic ducts, which is a separate procedure reported with code 43271 (ERCP with endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic ducts). Ductal dilation is done when there is a stricture of one of the ducts, says Minocha. Even the balloons used for the two procedures are different. For the stones themselves, no ductal dilation is done.

Lithotripsy with ERCP Is Reported with 43265

The gastroenterologist also may use lithotripsy to crush and destroy the stones. Code 43265(ERCP with endoscopic retrograde destruction, lithotripsy of stone[s], any method) is used to report the destruction of stones when performed in conjunction with an ERCP. Mechanical lithotripsy is a commonly used method for stone destruction, in which a catheter is inserted directly into the duct [...]