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NOTES: trans-lumenal, endoscopic pancreatic necrosectomy

Eleen Posted Mon 12th of September, 2016 14:14:49 PM
I need help with this procedure: Endosonographic Finding Findings: An anechoic lesion suggestive of a pseudocyst was identified adjacent to the pancreatic body. There was a single compartment without septae. The outer wall of the lesion was thick. There was no associated mass. There was internal debris within the fluid-filled cavity. After a suitable location for cyst-gastrostomy was identified, the electrocautery enhanced Axios system was advanced through the stomach wall and into the cystic cavity under ultrasound guidance through an avascular pathway. The fully covered, lumen opposing metal stent (Axios) was then deployed creating a cyst-gastrostomy tract. The stent lumen was then dilated using a 12-15mm balloon dilator to 15mm under fluoroscopic guidance. The cavity was then endoscopically explored. Then entire cavity was filled with solid necrosis. Almost all of the solid necrosis was then removed using a combination of lavage and suction and spiral snare. Impression:- Walled off pancreatic necrosis. - After EUS guided cyst-gastrostomy, necrosis almost all completely debrided endoscopically.
SuperCoder Answered Tue 13th of September, 2016 02:02:23 AM


The above mentioned procedure is EUS guided cyst-gastrostomy, in which drainage of pseudocyst was performed. The most appropriate CPT is CPT 43240 (Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed).his code includes the biopsy of the adjacent structures (to stomach and duodenum). This codes is used for the drainag of the pancreatic pseudocyst.Pancreas is adjacent to these organs and therefore we can use this code for endoscopic ultrasound guided.

Hope this helps.


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