can I code 43274 ERCP w/Insertion Tube with 43277 ERCP w /balloon Dilation of Ampulla?
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Tag Archives: ERCP
Dx for status post ERCP?
Could I get some help with a diagnosis code for – status post ERCP with sphincterotomy
The diagnosis I have been coming across is Z96.89, but I am not sure that is correct.
TIA
KM
ERCP 43273 add on code
Hi, I am new to Gastroenterology my (question is; does this warrant added on code 43273 (bile duct was deeply cannulated with the short nosed traction sphincterotome, contrast injected, I personally interpreted the bile duct images). see note below for detail:
The esophagus was successfully intubated under direct vision. The scope was advanced to a normal major papilla in the descending duodenum without detailed examination of the pharynx, larynx, and associated structures, and upper GI Tract. The upper GI tract was grossly normal. The bile duct was deeply cannulated with the short – nosed traction sphincterotome. Contrast was injected. I personally interpreted the bile duct images. There was brisk flow of contrast through the ducts. Image quality was excellent. Contrast extended to the entire biliary tree. The cystic duct was obstructed. The common bile duct contained multiple stones, the largest of which was 6 mm in diameter. The common bile duct was mildly dilated and diffusely dilated. The largest diameter was 10 mm. An 8 mm biliary sphincterotomy was made with a traction sphincterotome using ERBE electrocautery. There was no post sphincterotomy bleeding. The biliary tree was swept with a 12 mm balloon starting at the bifurcation. 8-10 stones were removed. No stones remained.
Physician reported CPT codes: 43264 43262
Is this correct, or can we bill 43273 too?
Appreciate any comments.
Michele CIRCC
ERCP fluoroscopy
My boss, a gastroenterologist, did 43262 and 43264 on same patient, same out-patient encounter. How do I code the fluoroscopic aspect? Is it included or should I use 74328? Thanks!
Ercp with physician assist
I have a new provider who doesnt have permission yet or complete the hospital requirements to perform an ercp on her own. Our established physicians "assist" her in the procedure.
How do i submit this bill? Hospital says she cant bill for it? Can i use a modifier? Do i submit the claim with established provider as the rendering provider? Documentation needs to have both doctors names or each need to do a separate operative report?
How do i submit this bill? Hospital says she cant bill for it? Can i use a modifier? Do i submit the claim with established provider as the rendering provider? Documentation needs to have both doctors names or each need to do a separate operative report?
Please .. And advise will help
thank you,
nicole cpc
ERCP or EGD?
Intended procedure was ERCP but note states they were not able to successfully cannulate. However, the note says partial cholangiogram and pancreatogram performed. Which code is more appropriate to bill? 43235 or 43260?
ERCP w/ stent removal and stent placement not in same areas
I would like insight into how you would code the following stent removal not in the same area as subsequent placement(s) – 1 stent removed from biliary tree, 1 stent placed into left hepatic duct, 1 stent placed into right hepatic duct.
One stent was removed from the biliary tree using a snare. The stent was found to be occluded via the water column test. A short 0.035 inch Soft Jagwire was passed into the biliary tree into the right intrahepatic ducts. The short-nosed traction sphincterotome was passed over the guidewire and the bile duct was then deeply cannulated….The upper third of the main bile duct, hepatic duct bifurcation and left and right hepatic ducts separately (Bismuth II) contained a single segmental stenosis 15 mm in length. A short 0.035 inch Soft Jagwire passed successfully into the left intrahepatic branches. The hepatic duct bifurcation and the left main hepatic duct were successfully dilated with an 8 mm balloon dilator. One 10 mm by 8 cm transpapillary uncovered metal stent was placed 7 cm into the left hepatic duct. Bile flowed through the stent. The stent was in good position. One 10 mm by 8 cm transpapillary uncovered metal stent was placed 6.5 cm into the right hepatic duct. Bile flowed through the stent. The stent was in good position.
73274,73274.59, but what for the stent removal? 43275 can’t be billed with 73274. 43276 then I can’t use 73274 for 2nd stent placement. Thoughts?
Wiki Ercp
"INDICATION: Biliary obstruction secondary to CBD stone.
DESCRIPTION OF PROCEDURE: Risks and benefits were explained to the patient and informed consent was obtained. The procedure was
done in the endoscopy suite with the assistance of Dr. X for the rendezvous procedure with a previously placed percutaneous stent and wire, which was extended transhepatic into the common bile duct and grabbed with a snare through the
sphincterotome. Cholangiogram showed a large proximal biliary stone in the area of bifurcation. A 1-cm sphincterotomy was done
and the duct was swept with 10- to 12-mm biliary balloon, with extraction of a proximal obstructive stone. At the end of the case, occlusion cholangiogram did not show any additional filling defect with a clean common bile duct otherwise.
IMPRESSION: Status post sphincterotomy and extraction of a large obstructive biliary stone."
For the above scenario what will be the CPT codes?
Coding EUS and ERCP on same day
Hi. I am new to the coding world. I work for a GI physician. He did an EUS and an ERCP with fluoroscopic guidance. I billed it as I was instructed as 43274-59 (ERCP with stent placement), 43259 (EUS), and 74328-TC. I just saw that it has been rejected as incorrect coding. The notes state that EUS was done, and ERCP with placement of 7 French 7-cm stent across the common bile duct without complication. And fluoroscopic guidance was performed for this procedure that he personally performed and interpreted the images of the fluoroscopy. Can anyone offer any insight on what I did wrong here? Any assistance would be greatly appreciated. Thank you.
How would this GI ERCP be coded?
EXTENT OF EXAM: second portion of duodenum
Findings: EGD: Normal esophagus, stomach, duodenum. No stent
seen exiting the ampulla. EUS: Linear EUS performed via
esophagus, stomach, duodenum. There is a hyperechoic metal bile
duct stent with acoustic shadowing seen within the CBD. The
common hepatic duct proximal to the CBD stent is normal in
appearance without stones. No gallbladder seen. Homogeneous
pancreas without masses. PD is normal in course and caliber
measuring 1-2 mm in the body of the pancreas. Few 4-6 mm
well-defined, triangular lymph nodes which are mostly hypoechoic
with hyperechoic center. Normal left lobe of liver. Normal
peripancreatic vessels including celiac axis. Normal left
adrenal gland, left kidney spleen. ERCP: TJF scope was used.
Ampulla with signs of previous sphincterotomy but no stent seen
exiting the ampulla. Stent is also visualized on fluoroscopy
and had clearly migrated proximally into the bile duct.
Selective bile duct cannulation easily achieved using balloon
tipped catheter loaded with 0.025 in guidewire. Bile aspirated.
Balloon sweep performed using 11.5 mm balloon to try to move
metal bile duct stent more distally but the balloon removed
moderate amount of stone debris from the stent/bile duct without
moving the bile duct stent. Then, we dilated the ampulla/distal
bile duct using TTS CRE balloon to maximum of 10 mm to help
facilitate stent removal. Following dilation of distal bile
duct/ampulla, the dilation balloon was inflated within the metal
stent and this allowed the metal stent to be moved distally such
that the distal aspect of the stent was now visible outside the
ampulla. The dilation balloon was deflated and removed. Then,
the metal stent was grasped using rat tooth forceps and removed
from the mouth. The scope was reintroduced and selective bile
duct cannulation achieved again using balloon tipped catheter.
Multiple balloon sweeps performed using 8.5 and 11.5 mm balloons
with removal of small amount of stone debris. Occlusion
cholangiogram showed CBD measuring 7-8 mm without any evidence
of leak, stricture or filling defect. Contrast drained very
well. Multiple balloon sweeps performed to clear any residual
contrast. Excellent drainage of bile and contract at the end of
the case. Pancreatic duct intentionally not cannulated and
pancreatogram intentionally not performed. I personally
interpeted all fluoroscopic imaging of bile duct as described
above.
Endoscopic Diagnosis: 1) Proximally migrated fully covered
metal bile duct stent (seen on EUS). 2) ERCP with bile
duct/ampulla balloon dilation, stone debris removal, metal bile
duct stent removal. Cholangiogram shows no further bile duct
stricture, leak or bile duct stones.