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ERCP Coding

  1. #1
    Default ERCP Coding
    Medical Coding Books
    When the Dr does a balloon sweep for stones, is this coded with 43271 (balloon dilatation) or just 43264 (removal of calculi)? Also, if he does the balloon sweep but no stones are found, can I still bill this since he attempted? Thanks in advance for your help!

  2. #2
    Charlotte, NC
    43264, if stones are found and removed, otherwise 43271

    according tothe AAPC Specialty Study Guide Gastroenterology 2007 pg 76:

    "During an ERCP, your gastrenterologist extracts 4 stones from the pt's pancreatic duct using a basket technique.

    The basket technique.....

    To report this procedure you should use 43264. You should submit a single unit of 43264, regardless of the number of calculi the physician extracts. And you would stick with this code if the gastroenterologists uses a balloon to remove stoes rather than a basket.

    Warning: You might be tempted to report 43271 in addition to 43264, but you shouldn't because there's no ductal dilation when the physician removes calculi, even if she uses a balloon during the procedure."

    Now I have all kinds of other books for gastro and I don't see anything like this anywhere else, but I also don't see anything that would negate the previous statement either.
    Last edited by coachlang3; 04-21-2010 at 11:52 AM.

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