Eleen Posted Tue 18th of October, 2016 12:15:13 PM
Based on the report, can we bill CPT 43274 & 43262, Stent was placed in commom bile duct, unclear of location for the Sphincterotomy. Thank you in advance.
The middle third of the main bile duct contained a single severe stenosis 10 mm in length. The lower third of the main bile duct, upper third of the main bile duct, hepatic duct bifurcation, left main hepatic duct and right main hepatic duct were moderately dilated. The largest diameter was 16 mm. There was brisk drainage of the pancreatic duct and selective cannulation of the pancreatic duct was not possible. A long 0.035 inch Soft Jagwire passed successfully into the left main hepatic duct. A 3 mm biliary sphincterotomy was made with a monofilament Autotome sphincterotome using ERBE
electrocautery. There was no post-sphincterotomy bleeding. To discover objects, the biliary tree was swept with an 11.5 mm balloon starting at the bifurcation. Sludge was swept from the duct. Debris was swept from the duct. Pus was swept from the duct. One 10 mm by 8 cm covered metal stent was placed into the common bile duct. Bile and pus flowed through the stent. The stent was in good position. Indomethacin suppositories were given to help prevent post-ERCP pancreatitis.
SuperCoder Answered Wed 19th of October, 2016 08:09:46 AM
CPT code 43274 and 43262 can not be bill together if both procedure are performed in the same duct. CPT code 43262 (Endoscopic retrograde cholangiopancreatography [ERCP]; with sphincterotomy/papillotomy) is bundled into 43274(Endoscopic retrograde cholangiopancreatography [ERCP]; with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent). Kindly verify your documentation, if the ducts are different then you can bill both codes together.