ASGE members may submit coding inquiries electronically to codingquestions@ASGE.org. 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 bill for use of fluoroscopy during an ERCP, especially when it’s an incomplete ERCP and we have to bill an EGD? Do you know the requirements for billing fluoroscopy?
Answer
Fluoroscopy is always utilized with ERCP, so CPT code 76000 is not to be reported.
Question #2
Can you help me understand the proper way to check if a visit can be billed just under the doctor when it was a split-shared visit in the hospital? What are the documentation requirements that would allow us to bill under just the doctor? I know we would need to check medical decision-making; however, I wanted to be clear on the requirements that would allow it to be billed with the doctor.
Answer
The practitioner who performs one of the three key evaluation and management components (history, examination or medical decision-making) or more than half of the total time spent by the provider. When one of the three key components is used to determine the substantive portion, the practitioner who bills for the visit must have performed that component in its entirety.
Keep in mind that per the Centers for Medicare and Medicaid Services, effective January 1, 2024, split-shared visits can only be billed by time, and the visit would be billed under the provider who spent more than 50 percent of that total time.