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EUS with drainage of pancreatic pseudocyst

Dawna Posted Mon 28th of January, 2013 15:02:18 PM

What would the cpt code be for the following procedure:

Procedure: Upper EUS

The duodenoscope was introduced through the mouth, and advanced to the second part of the duodenum.
EGD: Normal esophagus, stomach and duodenum. EUS: Previously know cystic lesions in the body/tail region seen, the cluster was about 2-3 cm in size. The cystic lesions did have some echogenic thickening of the walls. FNA of these body/tail region was done with 22 gauge needle and sent for cytology (very thick mucus seen on aspirate, cound not suction the fluid for CEA). The rest of the pancreas not seen as covered by the pseudocyst. There was a large pseudocyst with heterogenous material in it. About 6 cc of serous fluid was aspirated and sent for CEA, amylas, lipase. The cyst wall/stomach wall was 4 mm. Under fluoroscopy a 19 gage needle was passed and a 0.35" guidewire was coiled in the psuedocyst with several loops of the wire formed. Needle knife was used to gain entry into the pseudocyst and then the tract dilated to 6 mm with hurricane balloon. 2 double pig tail stents (10 Fr x 7 cm and 10 Fr x 4 cm) were then placed and appropriate drainage of contents seen.

Impression: Pancreatitis complicated by pseudocyst status post endoscopic cystgastrostomy.

If I am reading this correctly, the physician is calling this procedure a cystgastrostomy. However, I don't see that an anastomosis from cyst to gi tract was performed. What CPT code(s) should be assigned?

SuperCoder Answered Tue 29th of January, 2013 21:02:59 PM

This is a complex case. I have forwarded this query to my Gastro Editor. He will get back soon with a definitive answer. Thanks for being patient.

SuperCoder Answered Thu 31st of January, 2013 19:20:34 PM

43242 for the FNA biopsy
43256 for the stent placement (it includes dilation too)
43240 for the drainage of the pseudocyst

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