Wiki Unsuccessful ERCP

[tpontillo]

My biller had billed and egd 43239 with 576.8 (obstructive jaundice). Of course we got denied from Medicare because of the diagnosis. When I pulled the op report this was an unsuccessful ERCP. Do we bill the ERCP with a 53 modifier or does this turn into an egd? The doctor aborted the ERCP because of floppy ampullary anatomy and looping in the stomach. He took biopsies of the ampulla. What is the best way to code this?

 

[blathrop19@gmail.com]

I'm not 100% on this, but I feel like 43261 (ERCP w/ biopsy) and a 53 modifier would be appropriate. I like the doctors use of "floppy" you don't see that word too often in an op report.

Bob

 

[MaryKayDavid]

ercp

I agree with bob about ERCP (bx?) and use the 53 for the discontinued procedure.

 

[tpontillo]

Thank you Bob and Mary, I am going to change the code and refile