Wiki Incomplete ERCP

[kmordway]

Anyone bill an incomplete ERCP where a duct was not cannulated? 2014 CPT directs to report ERCP attempted but with unsuccessful cannulation of any ductal system to see 43235-43259.

During an attempted ERCP, my doc could not find the ampullary opening but did a precut sphincterotomy where he thought the ampulla should be, to attempt gain access to the bile duct. No bile was seen, reattempted to cannulate the area, but was unsuccessful and aborted the procedure.

So for all this work, we are supposed to bill 43235? wRVU is significantly lower. There is no code within the EGD code set that even comes close to the work that was performed. Suggestions???

 

[Karyne]

Answer found???

Have you ever find the answer to that? I am researching the same issue now? I think I could add the CPT 47460 to 43235 but I am not sure. Thank in advance for any help you can provide!

 

[jojogi]

I would think that you could use the 43235 with a 22 modifier as long as the documentation clearly states all of the extra work that was done.

 

[afalcon@dhcla.com]

you have to go back to 43235 if no ducts were cannulated.

 

[ewilliams941@gmail.com]

It's an EGD 43235, but DX coding creates a problem

I know the CPT directs us to code an EGD 43235 for unsuccessful cannulation of either duct. And I have. Unfortunately most of our ERCPs are needed because of DX K80.50, K80.51, K83.9, and similar etc. The problem this can create is that those DX codes are often not on the LCD for 43235 and frequently are denied claims due to LCD.

Has anyone else come into this problem with LCD denials because we attempted to perform and ERCP but had to down-code to EGD because ERCP was incomplete?

 

[GastroGal]

I would bill the 43262 with a 53 modifier, since the provider initiated the ERCP procedure.