Gastroenterology Coding Alert

Question: Last week, one of the physicians in our practice performed a diagnostic endoscopic retrograde cholangiopancreatography (ERCP). The procedure required more fluoroscopic guidance than a normal ERCP. Is there any way we can receive reimbursement for the extra fluoroscopy?

Arkansas Subscriber Answer: In October 2003, the National Correct Coding Initiative (NCCI) officially outlawed coding for fluoroscopy during a diagnostic ERCP. 

On the claim, you should report only 43260 (Endoscopic retrograde cholangiopancreatography [ERCP]; diagnostic, with or without collection of specimen(s) by brushing or washing [separate procedure]).

In fact, all of the ERCP codes (43260-43272) now include fluoroscopy, regardless of time or resources used. The edit means you can never report an ERCP and a fluoroscopy separately with either:

76000 - Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or

76001 - Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]). Exception: If your physician is the official reader of the x-ray cholangiogram, you can add the claim for interpretation of the radiology study with modifier -26 (Professional component) appended.