# ERCP with a snare



## jojogi (Jun 2, 2011)

Please read the note below.  Would I be able to use the 43251 code for the snare?  I have the 43262, 43258 but am not sure about the code for the snare.  I do not see anything in the CCI Edits about using this code with the ERCP codes but I want to see if anyone else has ever coded this procedure before.  Any help would be appreciated.  Thanks a million!

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PROCEDURE PERFORMED: Endoscopic retrograde cholangiopancreatography with
ampullectomy.

INDICATIONS: History of familial adenomatous polyposis with ampullary
adenomatous polyp identified.  The patient had undergone an endoscopic
ultrasound that showed an intact muscularis propria.

INSTRUMENT: Olympus ERCP endoscope.

MEDICATIONS: Demerol 150 mg IV, Versed 7 mg, Phenergan 25 mg IV.

COMPLICATIONS: None.

TECHNIQUE: Informed consent was obtained from the patient.  The patient was
placed in the prone position.  Conscious sedation was administered as
above.  The endoscope was passed through the mouth and advanced to the
second portion of the duodenum.  The ampulla was identified and appeared
polypoid with adenoma that measured about 1 cm.  The scope was advanced
into the pancreatic duct and the pancreatogram was normal.  A snare was
then used to encircle the polyp and cautery applied to completely resect
the ampulla.  This was then retrieved with a Roth net and specimens sent to
pathology.

FINDINGS: Normal appearing common bile duct and pancreatic duct.  No
filling defects were identified.  An adenomatous polyp that measured about
1 cm was seen.  This was resected using the snare cautery polypectomy.  The
specimen was completely resected and the sample sent of the specimen to
pathology.  A small biliary sphincterotomy was performed.  A 5-French x 5
cm prophylactic pancreatic stent was placed in good position.

IMPRESSION: As above.  Complete resection of ampullary adenoma. Normal
common bile duct and pancreatic duct on endoscopic retrograde
cholangiopancreatography.  A 5-French prophylactic pancreatic duct stent
placed.


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## tpontillo (Jun 2, 2011)

I only see 43261, the removal of the polyp, and the 43268, insertion of stent.  the 43258 is an ablation of the tumor.  He did not do that.  The 43251 is and EGD not an ERCP.  The ERCP codes start at 43260.


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## jojogi (Jun 2, 2011)

Oops, I meant to say 43268, not 43258 .  Also, I thought 43261 was biopsy only not polyp removal (snare).  Thanks for your help!.  I appreciate your feedback.


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## tpontillo (Jun 2, 2011)

I didnt see a code for ERCP with Snare so I thought the one with biopsy was the closest match.  The op note did say they sent the polyp out for biopsy.  This is how I would have billed it.


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## bridgettemartin (Jun 3, 2011)

We use an unlisted for a snare ampullectomy - 44799


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## jojogi (Jun 4, 2011)

Thanks everyone.  We learn something new everyday.


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## russmam (Jun 13, 2011)

*Ercp*

In this case, I would use 43261 , 43262, 43268, 43273
I don't see documentation for the cannulations of the bile and/or pancreatic
ducts....   get your docs to document the cannulations so that you can capture
the professional components of 74328, 74329, 74330... these take a -26 modifier.

Mary Jo Russman, BA, CPC, CGIC, CMC
Cleveland Clinic
Digestive Disease Institute


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