Gastroenterology Coding Alert

Question: During an ERCP, the gastroenterologist made numerous attempts with the catheter tip and with the guidewire, all of which failed. Then he used the standard Hydratome™, (or similar special sphinteratome) but over the course of an hour, the physician did not perform a single direct cannulation of either the common bile duct or pancreatic duct, nor did he insert the wire or contrast. What modifier should I use for this?

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Answer: During an ERCP (endoscopic retrograde cholangiopancreatography), visualization of the bileducts and the pancreatic ducts is an integral part of the standard procedure. If your gastroenterologist runs into problems visualizing any of the ducts (bile and pancreatic), he has performed an incomplete procedure.

In the case of many endoscopic procedures, when incomplete/reduced or discontinued, there are modifiers 52 (Reduced services) and 53 (Discontinued procedure), respectively, that may be applied. However, in the case of ERCP, there is a clear instruction in the CPT^® introduction to the ERCP section that states, “To report ERCP attempted but with unsuccessful cannulation of any ductal system, see 43235-43259, 43266, 43270.” This means that only an esophagogastroduodenoscopy procedure was performed, for which you would report 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]) if no biopsies or other therapeutic procedures were performed. Thus, a failed ERCP is not only time-intensive but also is paid at a significantly lower level.