Gastroenterology Coding Alert

Question: One of our doctors performed an endoscopic stent removal in the bile duct. I-m not sure how to code this and was wondering if I should use 43269. How should I code for this procedure?

Alabama Subscriber

Answer: You-re right that you should use 43269 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of foreign body and/or change of tube or stent), but if your physician also reports his own x-rays, don't forget about 74328-26 (Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation; professional component). This is not a procedure that the doctor does in the office, so adding modifier 26 covers use of the room, equipment and having the technician available at a facility.
 
In limited circumstances, you may be able to report ERCP radiologic supervision and interpretation using 74328, 74329 (Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation) or 74330 (Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation), 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 your GI physician provides the radiological service in a facility setting.