Gastroenterology Coding Alert

Question: My gastroenterologist did an intraoperative sphincterotomy. The surgeon is billing for the exploratory gastrotomy. My gastro stepped in and used the endoscope to visualize the ampulla before performing the sphincterotomy. He wants to bill 43262, but the approach is throwing me off because this was an open procedure. The postop report said, "Roux-en-Y gastric bypass; has developed biliary tract symptoms with dilated duct documented by film. Elevated liver function. Ab pain." How should I code this?

Colorado Subscriber

Answer: This sounds like an ERCP. If your gastroenterologist at least cannulated the bile duct, you can use 43262 (Endoscopic retrograde cholangiopancreatography [ERCP]; with sphincterotomy/papillotomy).

This code reads as an endoscopic examination of the hepatobiliary system and does not specifically state that the physician must perform this service through the GI tract. Therefore, you should be OK with the gastro performing it during an open procedure. Just make sure his documentation states he successfully cannulated the bile duct.