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Endoclip placement on a tear during ERCP?

Maarit Posted Fri 10th of February, 2012 21:24:13 PM

I have coded the below OP report as follows:
Dx 574.51, 574.21 CPT 43264, 43262, 43271, 43235 -59, 43273, 74360
I'm unsure if the documentation supports EGD and the fluoro. Also, how would you code the placement of an endoclip on a tear...or would this be bundled?

The side-viewing duodenoscope was passed through the mouth and advanced with ease to the 2nd portion of the duodenum. The visualized esophageal and gastric mucosa are normal. The ampulla appears a bit prominent but has no evidence of recent stone passage. Cannulation of bile duct was achieved on first attempt with wire guide. Common bile duct was filled with contrast.numerous filling defects. Because of the numerous stones, a sphincterotomy was followed by 8 mm CRE balloon dilatation of the cut and then a 12 and 18 mm stone extraction balloons were used to extract the stones. There was a 4 mm long mucosal tear above the roof of the sphincterotomy and there an endoclip was placed to close it down. After clip was placed the bile duct was cannulated again and non-occlusion by the clip was verified. Fluoroscopy interpretation during procedure by myself.

SuperCoder Answered Sun 12th of February, 2012 18:40:08 PM

I suggest not to use 43235 -59 as this is a diagnostic procedure and inherent to other procedures. Modifier 59, even though allowed, but truly allowed for a different purpose in a different session on same day, but not in same session as in this case.
But, you can get payment for the same and endoclip by coding it differently. There is no specific code for Endoclip. As there was a mucosal tear, if the endoclip is placed to control bleeding, then you can code 43255, in place of 43235.

Maarit Posted Thu 16th of February, 2012 16:02:41 PM

Thank you, Sanjit. What about charging for the fluoro with a note like that?

Carol Answered Wed 04th of April, 2012 13:20:19 PM

I am a little confused regarding the charging of control of bleed. I was always taught that if the physician somehow caused the "bleed" - (sphincterotomy) - you cannot bill for the repair. Is this correct?

SuperCoder Answered Thu 05th of April, 2012 08:30:52 AM

Yes, correct. If the bleeding is caused during the surgery by accident by the surgeon(s) only, you cannot charge for the control of that bleeding. In that case, the control is included within the charge of the main surgery.

Ifthe surgery is being performed specifically for control of bleeding only, then obviously you can bill the specific bleeding control code.

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