Wiki Balloon Sweeep w/o Removing Stones

[kathleenjean84]

Can we bill for a 43264 when they discover no stones present? Or can we bill with a 52 reduced services modifier? The doctor still did the procedure, there just wasn't any stones present. Thanks from Digestive Health Associates of Southwest Michigan!

 

[blathrop19@gmail.com]

At that point I've heard you can bill 43271 for balloon dialation.

Bob

 

[russmam]

Ercp

During ERCP, it is routine to do a sweep to make sure the ducts are clear.
In the event that sludge and stones were removed.... charge 43264.
I would not use 43271 unless it is specifically documented that the bile duct and / or pancreatic duct was dilated during the procedure. If there are no stones, I would use 43260.

Mary Jo Russman, CPC, CGIC, CMC
Cleveland Clinic Digestive Disease Institute