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Bundling question for ERCP codes

Kathy Posted Fri 11th of October, 2013 16:01:29 PM

GI provider reported codes 43264,43262-51 & 43271-51. Patient's insurance has denied 43271-51 stating it is inclusive to 43264. Is it appropriate to report both? Should modifier 59 be appended to 43271 if it is appropriate?

SuperCoder Answered Fri 11th of October, 2013 18:07:48 PM

Don't be tempted to report CPT code 43271 (… with endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic duct[s]) in addition to CPT code 43264. You shouldn't do this because there is no ductal dilation when the physician removes calculi, even if they use a balloon during the procedure.

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