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43256 and 43499 unlisted esophagus

Eleen Posted Wed 14th of November, 2012 14:13:35 PM

The Endoscope was introduced through the mouth, and advanced to the antrum of the stomach. The upper GI endoscopy was accomplished without difficulty. The patient tolerated the procedure well.The examined esophagus was normal.
Two previously placed, double-pigtail, trans-gastric stents and one naso-cystic tube were seen in the body of the stomach. The naso-cystic tube and one of the stents were removed with a snare. The cyst-gastrostomy tract was cannulated with a
wire-guided balloon dilator and the tract was dilated using a 15-16.5-18mm TTS balloon dilator up to a maximum diameter of 18mm. The cyst cavity was then endoscopically explored. The entire cavity remained filled with solid necrosis. Approximately 33% of the solid necrosis was removed endoscopically using a combination of lavage and suction and spiral snare. Over 1 hour was spent just removing solid necrosis from the cyst cavity. Two 10Fr by 4cm plastic, double-pigtail stents were then placed across the cyst-gastrostomy tract.- Previously placed naso-cystic tube and one trans-gastric stent removed.
- Persistent solid necrosis within cyst cavity. After dilation of the cyst-gastrostomy tract, approximately33% of the persistent necrosis was successfully removed endoscopically.
- Two new 10Fr double-pigtail trans-gastric stents placed.

So our Physician is stating that he removed the Pancreas endoscopically. Would I use cpt 43256? and also the unlisted procedure code. Physician is calling this non standard procedure?

SuperCoder Answered Thu 15th of November, 2012 04:57:46 AM

"Over 1 hour was spent just removing solid necrosis from the cyst cavity. " I would recommend using 43256-22 to show the extra work done.

This will eliminate us the use of 43499. Dilation will be inclusive

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