# EGD Non standard procedure



## erikal01 (Nov 6, 2012)

The Endoscope was introduced through the mouth, and advanced to the antrum of the stomach. The upper GI endoscopy was accomplished without difficulty. The patient tolerated the procedure well.The examined esophagus was normal.
Findings:
Two previously placed, double-pigtail, trans-gastric stents and one naso-cystic tube were seen in the body of the stomach. The naso-cystic tube and one of the stents were removed with a snare. The cyst-gastrostomy tract was cannulated with a
wire-guided balloon dilator and the tract was dilated using a 15-16.5-18mm TTS balloon dilator up to a maximum diameter of 18mm. The cyst cavity was then endoscopically explored. The entire cavity remained filled with solid necrosis. Approximately 33% of the solid necrosis was removed endoscopically using a combination of lavage and suction and spiral snare. Over 1 hour was spent just removing solid necrosis from the cyst cavity. Two 10Fr by 4cm plastic, double-pigtail stents were then placed across the cyst-gastrostomy tract.- Previously placed naso-cystic tube and one trans-gastric stent removed.
- Persistent solid necrosis within cyst cavity. After dilation of the cyst-gastrostomy tract, approximately33% of the persistent necrosis was successfully removed endoscopically.
- Two new 10Fr double-pigtail trans-gastric stents placed.

So our Physician is stating that he removed the Pancreas endoscopically.  Would I use cpt 43256? and he keeps on calling this non standard procedure? Very confused


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## jaa8237 (Nov 13, 2012)

You may want to look at an unlisted code for these new procedure/s used to remove necrotic tissue/s endoscopically that are taking additional time and advanced techniques.  There is not a current CPT code/s to pick from for a lot of procedures that are being done endoscopically.  Pick the correct unlisted code for area and set a fee for the procedure that reflects the work done.  You will have to submit op notes because most insurance plans will initially deny the claim,  so make sure documentation reflects what the physician is doing. You might have to send in an appeal letter to get compensated, but sometimes there just is no code to use.  Hopefully we will see some new codes in the future.


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