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ERCP-scope through the gastrostomy

Heidi Posted Thu 13th of September, 2018 16:11:48 PM
What would i code for a "ERCP- duodenoscope was introduced through the gastrostomy, and advanced to the duodenum- and a sphincterotomy was performed."?
SuperCoder Answered Fri 14th of September, 2018 08:49:14 AM

Hi Sherry,

CPT code 47999 is an appropriate code if the ERCP is performed through gastrotomy and the correct code for sphincterectomy will be 46080.

Further query is welcome.

Good day!

Heidi Posted Mon 17th of September, 2018 09:05:04 AM
What base code will we use before the unlisted code? would 43235 be appropriate? since the ERCP went thru the gastrostomy and not the mouth, i am questioning it. Thank you for your help!
SuperCoder Answered Tue 18th of September, 2018 04:04:18 AM
Hi Sherry,
Kindly note that CPT code 43235 (Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) is not an appropriate code as are bundled by Medicare into the ERCP code and cannot be reported separately. In addition, the correct code combination to report ECRP via gastrotomy with sphincterotomy will be 47999 to report ERCP via gastrostomy (open or laparoscopic) (47999) and 47460-59 (Transduodenal sphincterotomy or sphincteroplasty, with or without transduodenal extraction of calculus (separate procedure). This separate procedure by definition is usually a component of a more complex service and is not identified separately. When performed alone or with other unrelated procedures/services it may be reported. If performed alone, list the code; if performed with other procedures/services, list the code and append modifier 59 or an X{EPSU} modifier.
Thanks
Good day!

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