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Gastroenterology Coding Alert

You Be the Coder:

Same-Day Consults and Procedures

Published on Wed Jul 07, 2004

Question: Our gastroenterologist was called to the hospital to consult on a patient who had severe pain in his midsection. She performed a level-two consultation on the patient and performed an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and removal of calculi from the common bile duct. Can we file for the consult and the ERCP?

Nevada Subscriber

Answer: Yes, you can file for both the consult and the ERCP. When the gastroenterologist performs an ERCP and a consult on the same patient in the same day, you should:

  • report 43264 (Endoscopic retrograde cholan-giopancreatography [ERCP]; with endoscopic retrograde removal of calculus/calculi from biliary and/or pancreatic ducts) for the ERCP.
  • attach modifier -59 (Distinct procedural service) to 43262 (Endoscopic retrograde cholangiopancre-atography [ERCP]; with sphincterotomy/ papillotomy) for the sphincterotomy.
  • attach modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99252 (Initial inpatient consultation for a new or established patient, which requires these three key components; an expanded problem-focused history; an expanded problem- focused examination; and straightforward medical decision-making) for the consultation.

    Remember: Modifier -25 must be attached to the consultation; you can only use it on evaluation and management services. If you append modifier -25 to the ERCPs (43262, 43264), your claim will be denied.

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