Gastroenterology Coding Alert

Question: Our gastroenterologist performed an endoscopic retrograde cholangiopancreatography (ERCP) on a patient, extracting three stones from her pancreatic duct using the basket technique. How should I report this?

Maryland Subscriber Answer:  When a patient has stones in her pancreatic ducts, doctors can employ several different methods to deal with the situation. One is the basket technique, in which the physician places a catheter with a basket over a guide wire into the ducts. The basket scoops up the stone, which is then withdrawn into the duodenum and let loose.

Report 43264 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of calculus/calculi from biliary and/or pancreatic ducts) for all stone removals using the basket technique in the bile or pancreatic ducts. Regardless of the number of stones the physician extracts, report 43264 only once.

You should also use 43264 if the physician uses a balloon to drag out the stones rather than using a basket. Some coders mistakenly report 43271 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic duct[s]) in addition to 43264, but this code cannot be reported because there is no ductal dilation when stones are removed, even if the physician uses a balloon during the procedure.