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ERCP billed w/base EGD

Heidi Posted Mon 23rd of July, 2018 10:28:00 AM
I have an ERCP that was done an an EGD that was done, there were no techniques done on that EGD, can we bill 43274 and 43235-51 OR 43274 and 43235-59? OR can we only bill the ERCP?
SuperCoder Answered Tue 24th of July, 2018 05:00:00 AM



Thank you for your question.


As per the provided documentation, you are advised to report CPT code 43274 only (ERCP).

Per NCCI edit guidelines, the codes designated as "separate procedure" should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.


Also, CMS does not allow separate reporting of a procedure designated as a “separate procedure” when it is performed at the same patient encounter as another procedure in an anatomically related area through the same skin incision, orifice, or surgical approach. 


Please feel free to ask any further questions.

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