Gastroenterology Coding Alert

Question: When my physician performs the radiologic interpretation for an ERCP, should I bill 74330-26?

New York Subscriber

Answer: During an endoscopic retrograde cholangiopancreatography (ERCP), visual guidance may be provided with fluoroscopy (a continuous x-ray technique) or another imaging tool. A gastroenterologist and radiologist usually perform the procedures in a facility or clinic. The gastroenterologist performs the surgical procedure, and the radiologist usually conducts the guidance and takes the x-rays.

For this typical scenario, you should report the gastroenterologist's services with the appropriate ERCP code (43260-43272). The radiologist should report the imaging with a radiologic supervision and interpretation (S&I) code (74328-74330).

If the radiologist is unavailable, the gastroenterologist may perform the imaging with a radiology technician's assistance. Although many gastroenterol-ogists will then look at the x-rays, a radiologist still usually examines the film and conducts the written report.

If your gastroenterologist dictates the full written radiology report and the radiologist performs no role, you can report 74330 (Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation). However, you would have to coordinate the billing with the radiologist and the facility, which may prove more troublesome and contentious than the reimbursement is worth.

If you decide to bill 74330, append modifier -26 (Professional component) to 74330 to indicate that you are billing for the physician's services only, unless your physician owns the imaging equipment.

You Be the Coder and Reader Questions answered by Linda Parks, MA, CPC, lead coder at Atlanta Gastroenterology Associates; and Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel.