# ERCP- Help!



## jojogi (Sep 16, 2010)

Sometimes I am confused on when to use the 43260 with other codes.  For this I think I should use 43260-59, 43262, 43264, 43265.  I looked on the CMS website and based on the MUE chart this is what I came up with.  Please advise.

ENDOSCOPY REPORT ----

TECHNIQUE:  AFTER OBTAINING INFORMED CONSENT, THE PATIENT WAS PLACED IN THE
PRONE POSITION.  BITE BLOCK INSERTED INTO THE ORAL CAVITY.  CONSCIOUS
SEDATION ADMINISTERED.  OLYMPUS VIDEOSCOPE WAS PASSED THROUGH THE
OROPHARYNX TO ESOPHAGUS THEN ADVANCED TO THE SECOND PORTION OF THE
DUODENUM.

FINDINGS:  THE PYLORUS APPEARED WITHIN NORMAL.  THE MAJOR PAPILLA WAS
CANNULATED AND THE CHOLANGIOGRAM WAS OBTAINED WHICH SHOWED DILATED COMMON
BILE DUCT WITH DIAMETER 12 TO 13 MM, AS WELL AS DILATED INTRAHEPATIC DUCTS.
A FILLING DEFECT WAS NOTED IN THE DISTAL COMMON BILE DUCT, MOSTLY
CONSISTENT WITH COMMON DUCT STONE.  A SPHINCTEROTOMY WAS PERFORMED WITH
DRAINAGE OF SLUDGE AND DEBRIS AS WELL AS PURULENT MATERIAL.  MULTIPLE
BALLOON SWEEPS WERE THEN PERFORMED WITH RETRIEVAL OF SLUDGE AND DEBRIS,
HOWEVER, ON REPEAT CHOLANGIOGRAM, THE FILLING DEFECT WAS STILL NOTED IN THE
DISTAL COMMON BILE DUCT.  THEREFORE, AN EXTRACTION BASKET WAS USED FOR
LITHOTRIPSY AND THIS WAS SUCCESSFUL.  A REPEAT CHOLANGIOGRAM AFTER
LITHOTRIPSY SHOWED NO FILLING DEFECTS WITHIN THE BILIARY TREE.

IMPRESSION:
1.   STATUS POST SUCCESSFUL SPHINCTEROTOMY.
2.   CHOLEDOCHOLITHIASIS, STATUS POST SUCCESSFUL LITHOTRIPSY.
3.   DILATED COMMON BILE DUCT AND INTRAHEPATIC DUCTS.


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## j.berkshire (Sep 16, 2010)

43260, the base code for the ERCP family, cannot be billed with the other ERCP-family codes; it is considered part of the description of all the codes in the family.  I suggest coding this report with 43262, 43264, 43265.


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## jojogi (Sep 16, 2010)

Thanks again!


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