Coding: Don't Bill for Both 43268 and 43269 With ERCP

Why This Topic Matters

These issues can affect whether claims are paid as submitted, bundled, or reduced when multiple ERCP-related services are reported together. Understanding the article helps coding and billing staff review claims for compliance and avoid preventable denials or payment adjustments.

Article Sections

1. Stent removal and insertion under Medicare

   Discusses ERCP-related stent services and how Medicare views the combination of related stent procedures on the same date of service. The section focuses on general billing context for gastroenterology claims.

2. Multiple procedures and modifier use

   Covers how reimbursement may be affected when more than one procedure is reported, including the role of payment reduction for additional services. It also addresses the use of a modifier in the context of multiple procedures.