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  • Posted by 17138, 2 years ago. There are 2 posts. The latest reply is from .
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  1. Please help with CPT Px codes:
    Dx:Abnormal MRCP, Established bile duct stone(s), For
    therapy of bile duct stone(s)
    Procedure:ERCP
    The Duodenoscope was
    introduced through the mouth, and advanced to the duodenum and used to
    inject contrast into the bile duct. The ERCP was accomplished without
    difficulty. The patient tolerated the procedure fairly well.
    The scout film was normal. The esophagus was successfully intubated
    under direct vision without detailed examination of the pharynx, larynx,
    and associated structures, and upper GI tract. The upper GI tract was
    grossly normal. The major papilla was on the rim of a diverticulum, but
    was otherwise normal. A 0.035 inch Hydrawire was easily passed into the
    biliary tree. The short-nosed traction sphincterotome was passed over
    the guidewire and the bile duct was then deeply cannulated. Contrast was
    injected. I personally interpreted the bile duct images. Ductal flow of
    contrast was adequate. Image quality was adequate. Contrast extended to
    the hepatic ducts.The lower third of the main bile duct contained
    multiple stones, the largest of which was 9 mm in diameter. The main
    bile duct was moderately dilated and diffusely dilated. The largest
    diameter was 11mm. An 8 mm biliary sphincterotomy was made with a
    monofilament short-tip traction sphincterotome using ERBE
    electrocautery. There was no post-sphincterotomy bleeding. There was
    spontaneous flow of clear bile and studge (no purulence noted). The
    biliary tree was swept with a 12 mm balloon starting with the
    distal-most stone and sequentially moving up the main bile duct with
    removal of 4-5 medium-sized stones (6-9mm). Occlusion cholangiogram
    revealed another filling defect (5mm) in the mid bile duct - stone vs
    bubble. The 15 mm balloon, 18 mm balloon and basket were used in an
    attempt to remove the remaining stone. The 15-18mm balloon was again
    advanced over the wire and an occlusion cholangiogram was performed (at
    18mm) with no obvious residual filling defects, however pt became
    somewhat agitated and removed the bite block and started to move, thus a
    detailed examination was not permitted. Many stones were removed and no
    stones were left. There was complete drainage of contrast at the end of
    the procedure. Pancreatic cannulation was intentionally not obtained and
    the wire was NOT intruduced into the pancreatic duct.

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