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Procedure: NOTES: trans-lumenal endoscopic choleodocho-gastrostomy

Eleen Posted Fri 23rd of December, 2016 10:39:39 AM
The Endosonoscope was introduced through the mouth, and advanced to the duodenal bulb. The upper EUS was accomplished without difficulty. The patient tolerated the procedure. Endosonographic Finding:There was dilation in the common hepatic duct which measured up to 15 mm. There was a large, poorly defined hypoechoic mass in the pancreas head surrouding the portal vein with a previously placed metal stent in the bile duct traversing the level of the mass. The stent was occluded. After a suitable location was located under ultrasound guidance with no intervening vessels, a 19 gauge needle was inserted into the common hepatic duct. 5ml of fluid was aspirated and was consistent with bile. Contrast was injected under fluoroscopic guidance and a cholangiogram was obtained. The common hepatic duct, bifurcation and intrahepatic system were diffusely dilated. The previously placed biliary stent was occluded and no contrast was seen flowing through the stent and into the duodenum. A long 0.025 inch Visiglide wire was advanced into the intrahepatic system. The needle was removed and the tract was incised with a needle knife. The tract was then dilated using a 4mm and 6mm balloon dilators. A 10mm by 6cm fully covered metal stent (Viabil) was then placed across the choledocho-gastrostomy tract. The stent was in good position and there was good flow of contrast and bile out of the biliary tree and into the stomach. I was thinking CPT Codes 43242 & 43266
SuperCoder Answered Tue 27th of December, 2016 01:45:23 AM

Greetings from SuperCoder.com!

 

As per provided documentation, you should report these 3 codes:

 

  1. 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
  2. 43242 -Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis)
  3. 74360 - Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation

 

Please feel free to write if you have any concern or questions.

 

Thanks.

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