Laura P asked:
I recently began billing for a gastroenterology practice. They have been billing cpt code 43264 ERCP w/ removal of calculus and cpt 43262 ERCP w/ sphincterotomy. They have been appending a 59 modifier on the 43262. I think this is unnecessary; per CCI edits. I am thinking a modifier is unnecessary; however the 43262 may be subject to the multiple procedures policy. Can someone tell me if I am correct? following op report:
Procedure: ERCP with ES and stone removal
Indications: Choledocholithiasis seen on CT; elevated liver enzymes and bilirubin; cholelithiasis
The endoscope was passed under direct vision. The endoscope was introduced through the mouth; and advanced to the duodenum and used to inject contrast into the bile duct and ventral pancreatic duct. The physical status of the patient was reassessed after the procedure. The ERCP was accomplished without difficulty. The patient tolerated the procedure well.
Findings:
2 stones in the common bile duct; status post ES and balloon dragging a successful removal.
Patent cystic duct.
Mild prominence of intra and extra hepatic bile ducts
Impression:
Procedure: ERCP with ES and stone removal. No stent placed.
I was thinking
43264
43262
with no modifiers. OR should it be 43277?
Is this op report rather incomplete? No description of the Sphincterotomy other than ES
Answer:
If you read the parenthetical notes under 43262; you will see you may code 43264. You are correct. you do not need modifier 59. It will be subject to the multiple procedure policy.
I recently began billing for a gastroenterology practice. They have been billing cpt code 43264 ERCP w/ removal of calculus and cpt 43262 ERCP w/ sphincterotomy. They have been appending a 59 modifier on the 43262. I think this is unnecessary; per CCI edits. I am thinking a modifier is unnecessary; however the 43262 may be subject to the multiple procedures policy. Can someone tell me if I am correct? following op report:
Procedure: ERCP with ES and stone removal
Indications: Choledocholithiasis seen on CT; elevated liver enzymes and bilirubin; cholelithiasis
The endoscope was passed under direct vision. The endoscope was introduced through the mouth; and advanced to the duodenum and used to inject contrast into the bile duct and ventral pancreatic duct. The physical status of the patient was reassessed after the procedure. The ERCP was accomplished without difficulty. The patient tolerated the procedure well.
Findings:
2 stones in the common bile duct; status post ES and balloon dragging a successful removal.
Patent cystic duct.
Mild prominence of intra and extra hepatic bile ducts
Impression:
Procedure: ERCP with ES and stone removal. No stent placed.
I was thinking
43264
43262
with no modifiers. OR should it be 43277?
Is this op report rather incomplete? No description of the Sphincterotomy other than ES
Answer:
If you read the parenthetical notes under 43262; you will see you may code 43264. You are correct. you do not need modifier 59. It will be subject to the multiple procedure policy.
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