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Wiki Ercp

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Skymom16

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Hi,

I'm in need of HELP, I have a 2015 claim still outstanding due to coding issues. Please see report
ERCP:
The previously placed stent was in good position.It was removed atraumatically with endoscopic snare.The papilla had a normal post-sphincterotomy appearance. Papilla was cannulaed with 9-12 mm balloon catheter. Cholangiogram was obtained after deep cannulation. Common bile duct was 8 mm in size without filling defects in it. A sweep was preformed using balloon catheter.Sludgy material was delivered .Good drainageof bile and contrast noted after the procedure .Pancreatic duct was not cannulated or specified during the procedure .

An EGD w/ biopsy was also performed . Claim was billed as followed .

99222-25
43275
43239 XS claim was denied due to incorrect modifier .

Report was then reviewed by a new coder and reposted charges as followed:

99222-25
43276
43264 51
43239 XS
74328 26
Keep in mind this claim is a Medical HMO plan .Claim was again rejected due to modifier.

If you can help as to is correct on the proper coding.

Thank you so much in advance .:confused:
 
Maybe the carrier did not recognize the XS modifier in 2015? We only had 2 local carriers utilize them in 2015; everyone else still wanted -59 modifiers until 2016 (and some still do!).
 
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