Gastroenterology Coding Alert

Question: If our gastroenterologist takes the aid of fluoroscopy during an ERCP procedure, I know that 77002-26 and 76000-26 are bundled into the ERCP procedure and cannot be reported separately. As far as my knowledge goes, 74328-74330 can be used with a 26 modifier if fluoroscopy is done during catheterization of the biliary or pancreatic ducts. Please tell me if this is correct? Also give me an example when 76000 is separately reportable?

Minnesota Subscriber

Answer: During most of the ERCP procedures, your gastroenterologist will take the aid of fluoroscopic imaging. But in most instances, your gastroenterologist will not be the person who will be doing the official supervision and image interpretations for the radiology aspect of the procedure. Most of the time, a radiologist will be present for the supervision and interpretations and will claim reimbursements for the same.

If the radiologist is not present for the fluoroscopy procedure and your gastroenterologist is the person who is doing the supervision and producing an official interpretation report, then you can bill the S&I in your gastroenterologist's name.

You are correct in the assumption that the radiological supervision and interpretations of the catheterization of the biliary or the pancreatic ducts are the only codes that you can separately report for an ERCP procedure. So depending on the ductal system visualized, you can report the following codes:

• 74328 (Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation)
• 74329 (Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation)
• 74330 (Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation)

In order to report these radiologic codes, your gastroenterologist should produce an interpretive report of the radiologic images separate from the report of the endoscopic procedure. Be sure that a radiologist is not also interpreting the images at a different time with a separate report and submitting the same codes in a claim of his own. Even though the code contains the phrase "radiological supervision and interpretation," you still have to append the modifier 26 (Professional component) to the code unless your gastroenterologist also owns the fluoroscopy equipment that is being used for the procedure.

Since ERCP codes (43260-43272, Endoscopic retrograde cholangiopancreatography [ERCP]...) includes fluoroscopy, you cannot report 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or 76001 (Fluoroscopy, physician time more than 1 hour, assisting a nonradiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]) as a separate procedure to bill for your gastroenterologist's time.