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ljohnsky

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2014 codes. UH! The physician did a 43265 Lithotripsy. 43274 Stent placement and 43262 Sphincterotomy and a 43261 biopsy. My Question is can you bill a 43274 with the 43262? The code book says that 43262 can be used with 43264,43265 and 43261. The sphincterotomy was used to make a cut for the balloon to be inserted and CBD debris was then swept out. My interpretation of the code book is that if we only bill 43274 and no other codes then sphincterotomy 43262 is included in that procedure of making the cut for stent placement. Please advise Thank you
 
I am new to GI coding and never coded something like this before. But I agree with you... I would think you would only code the 43274 because (when performed) it includes the sphincterotomy (43262).
 
Sorry, I don't have my CPT book with me but based on what/how you describe procedure, you can bill 43262 with the 43261 with a 59. you may have to appeal stating that it was used for that purpose. In addition, 43262 can be billed with 43264 if they are not done in the same 'duct'. Read the cpt & parathentical guidelines in the ERCP section and check the NCCI edits you may get more detail. I will review further and get back to you if I find any additional info
 
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