Gastroenterology Coding Alert

Question: One of the physicians in our practice performed a diagnostic endoscopic retrograde cholangiopancreatography (ERCP). The procedure required more fluoroscopic guidance than a normal ERCP. Is there any way we can receive reimbursement for the extra fluoroscopy?


Arkansas Subscriber

Answer: If you try to report 43260 (Endoscopic retrograde cholangiopancreatography [ERCP]; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) along with 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or 76001 (Fluoroscopy, physician time more than one hour, assisting a nonradiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]), you-ll only receive reimbursement for 43260.

According to the National Correct Coding Initiative (NCCI), all of the ERCP codes (43260-43272) include fluoroscopy, regardless of the time or resources your gastroenterologist uses. The edit means you can never report an ERCP and a fluoroscopy code separately.

Exception: If your physician is the official reader of the x-ray cholangiogram--in other words, performs the interpretation and writes the report--you can add the claim for interpretation of the radiology study with modifier 26 (Professional component) appended.

Depending on which duct system your physician images, you-ll report either 74328-26 (Endoscopic catheterization of biliary ductal system, radiological supervision and interpretation), 74329-26 (Endoscopic catheterization of the pancreatic ductal system ...), or 74330-26 (Combined endoscopic catheterization of the biliary and pancreatic ductal systems ...).