Gastroenterology Coding Alert

Question: My doctor performed an ERCP with pancreatic duct fluid collection. Her report did not give much detail. May I code it as 43260 with 74328?

Kansas Subscriber

Answer: Probably not. If what your gastroenterologist does is scope the patient and collect samples, you'd only code 43260 (Endoscopic retrograde cholangiopancreatography [ERCP]; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). That code includes the collection of samples.

The second code, 74328 (Endoscopic catheterization of biliary ductal system, radiological supervision and interpretation), is a radiology code for directing a catheterization, not a diagnostic procedure.

If your physician did, in fact, have the patient catheterized, you would be able to report 74328 (Endoscopic catheterization of biliary ductal system, radiological supervision and interpretation), but only if you can check off three items:

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

• No other physician may claim the same service.

• You should append modifier 26 (Professional component) to 74328, as appropriate, if your gastroenterologist provides the service in a facility setting.

If your gastroenterologist performs 89105 (Duodenal intubation and aspiration; collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube) in addition to the ERCP, code both procedures.