Forum - Questions & Answers

Jul 2nd, 2012 - CDonaldson

Ercp

I am trying to find out if you can bill CPT® code 43268 a second time with modifier 59 when the provider performs the procedure on both bile and pancreatic duct? The reason I ask if because the CPT® definition of this code states "bile or pancreatic duct", not and/or. I have the exact same question about CPT® code 43262. Any information you would be willing to share is greatly appreciated.

Jul 2nd, 2012 - nmaguire   2,606 

re: ERCP

If multiple stents are placed into the same duct, 43268 may only be used once.
If stents are placed into both the common bile duct and the pancreatic duct, it is possible to bill 43268 twice, appending modifier ‘-59’ to the second code to indicate that the second stent was placed at a different site. Payment based on payer policy



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