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ERCP Question

Sharon Posted Wed 30th of November, 2011 20:28:47 PM

Please help with CPT Px codes:
Dx:Abnormal MRCP, Established bile duct stone(s), For
therapy of bile duct stone(s)
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.

SuperCoder Answered Wed 30th of November, 2011 22:51:27 PM

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