Billing for Fluoroscopy During ERCP
Fluoroscopy is used the most during ERCPs. However, a radiologist will most likely bill for the fluoroscopic imaging during an ERCP and not a gastroenterologist. The majority of the time, there will be a radiologist present and he or she will be billing for the S&I, says Peter Pardoll, MD, a gastroenterologist in St. Petersburg, Fla., and the former co-chair of the National Gastrointestinal Carriers Advisory Committee.
Sometimes I cant get a radiologist to come down to the procedure room, so then I handle the radiological S&I with the assistance of a radiology technician, and I bill for the fluoroscopy. If you do the work, you should be the one to get paid for it.
In the rare case where a gastroenterologist performs the fluoroscopic supervision and guidance during an ERCP, CPT 2001 tells coders to use one of the following three radiological codes depending on whether the biliary, pancreatic or both ductal systems were visualized:
74328 endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation
74329 endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation
74330 combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation
Attach Modifier -26 to Radiological Code
Finally, many gastroenterologists question whether modifier -26 needs to be added to the radiological code. Certain medical procedures are made up of a physician (professional) component and a technical component, which represents the value assigned to the ownership and maintenance of the equipment. (Though CPT guidelines do not specifically address billing for the technical component of a procedure, Medicare and some commercial insurers have designated the modifier -TC to represent this.)
When a procedure has both professional and technical components, a gastroenterologist must own (or partially own by being a partner in a medical practice) the equipment being used to bill the global procedure code. If the physician does not own the equipment being used, modifier -26 should be added to the procedure code.
Some gastroenterologists argue that the use of the phrase radiological supervision and interpretation in all the fluoroscopy codes indicates that these codes are not made up of two components, but only the one professional component. Therefore, modifier -26 should not be added to any fluoroscopy code, and the physician should receive the higher reimbursement of the global code.
In fact, all of the ERCP codes (43260-43272) now include fluoroscopy, regardless of time or resources used. The edit means you can never report an ERCP and a fluoroscopy separately with either:
•76000 - Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or
•76001 - Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy]).
Exception: If your physician is the official reader of the x-ray cholangiogram, you can add the claim for interpretation of the radiology study with modifier -26 (Professional component) appended.