Wiki ERCP aborted


Saint Joseph, MO
Best answers
My doctor was going to do an ERCP but was only able to get to the duodenum before he had to abort the procedure. He dictates that the scope was advanced to a normal major papilla in the descending duodenum without detailed examination of the pharynx, larynx and associated structures, and upper GI tract. Payor is Medicaid so I am not sure if I should bill as an ERCP I don't think that is correct because I can't do modifiers with Medicaid to indicate it has been aborted. Do I bill EGD even though he says he did not do a detailed exam?

Also I had a physician who did an anoscopy in the office can I charge for both the established patient code and anoscopy code? (pt was not new to our office and anoscopy was not planned)

Thank-you for any help you can provide
Modifiers for Medicaid can be state specific but you should be able to use modifier -53 to show an aborted procedure. Correct coding is to use the CPT that represents the intent of the planned procedure. Attach your modifier when circumstances don't allow the completion of the procedure. Indicate the primary diagnosis that shows medical necessity for the procedure. Secondary diagnosis should be the reason the procedure was aborted. Hope this helps!