Gastroenterology Coding Alert

Question: Can we charge for fluoroscopy separately when the physician performs ERCP in the hospital? I have heard conflicting advice on this.


New York Subscriber

Answer: Fluoroscopy procedures 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) and 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]) are a standard component of diagnostic endoscopic retrograde cholangio-pancreatography (ERCP, for instance 43260, Endoscopic retrograde cholangiopancreatography [ERCP]; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

The AMA has long advised that you should not report 76000 or 76001 separately with ERCP procedures 43260-43272 (CPT Assistant, Spring 1994). In the third quarter of 2003, the National Correct Coding Initiative further solidified this guideline by bundling 76000-76001 to 43260-43272 for all Medicare payers and others who follow NCCI restrictions.

In limited circumstances, you may be able to report ERCP radiologic supervision and interpretation using 74328 (Endoscopic catheterization of biliary ductal system, radiological supervision and interpretation), 74329 (Endoscopic catheterization of the pancreatic ductal system ...) or 74330 (Combined endoscopic catheterization of the biliary and pancreatic ductal systems ...), as appropriate. In particular:

- The gastroenterologist must indicate in his notes that he supervised the ERCP, and he must also include his interpretation of the procedure in the note.

- No other physician may claim the same service. This can be problematic because, in a facility setting, the facility radiologist may have priority for all interpretations. If the hospital radiologist reports 74328-74330, the gastroenterologist may not report the service, even if he prepares a separate report. Insurers will only pay for the interpretation and report one time.

- You should append modifier 26 (Professional component) to 74328-74330, as appropriate, if the GI provides the service in a facility setting.