Gastroenterology Coding Alert

Question: The gastroenterologist performs a level-two office visit on a new patient, and then decides to perform an endoscopic retrograde cholangiopancreatography (ERCP) using fluoroscopic guidance. During the encounter, the gastroenterologist also performs a sphincterotomy. How many CPT codes can I report for this encounter? Tennessee Subscriber Answer: Most likely, three. On the claim, you'll probably report the following: • 43268 (Endoscopic retrograde cholangiopancreatography; with endoscopic retrograde insertion of tube or stent into bile or pancreatic duct) for the ERCP • 43262 (Endoscopic retrograde cholangiopancreatography; with sphincterotomy/papillotomy) for the sphincterotomy • 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making ...) for the E/M service assuming the physician based his decision to do the procedure on this initial evaluation • modifier 25 (Significant, separately identifiable [...]