ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month, ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
Can you provide the appropriate diagnosis code(s) for Lynch syndrome?
Answer
Z15.09 is the diagnosis code for Lynch syndrome; however, this is typically not to be used as a primary diagnosis. The provider should document any personal or family history as well.
Question #2
Can you please explain to me when it is appropriate to bill under CPT code 43277 (ERCP with balloon dilation)? Can it be billed with CPT code 43274 (ERCP with stent placement)?
Answer
If a balloon is used to dilate the duct prior to stent placement, then you can't bill 43277, only 43274. If dilation was done of a different area for a stricture, then you can bill it, but it would require modifier 59 or XS.