# Laparoscopic gastrotomy for ERCP access



## Carsil864 (May 14, 2019)

Patient with a history of gastric bypass had to have a laparoscopic gastrotomy to create access for an ERCP. This was done by 2 different surgeons; Gen Surg made the gastrotomy; GI doc did the ERCP. My Gen Surg doc wants to bill 49653 but I know that's not correct. I am thinking 43500 for the general surgeon.  This was all done during the same operative session. Any coding help on this is appreciated.


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## cpc2007 (Jul 21, 2019)

I see that you asked your question a couple of months ago, but wanted to respond in case you are continuing to encounter this scenario. I've had this exact scenario a few times. After discussion with several general surgery auditors/educators, we all agreed on unlisted code 43659 linked to the fee of 43500. The reason we went to the unlisted code instead of 43500 itself is because the lay description for 43500 states that the approach is a midline epigastric incision. Therefore, if a laparoscopic approach is used, the 43500 wouldn't quite fit. There is no established code for a laparoscopic gastrostomy for exploration which caused us to go with the unlisted code. 

I hope that helps - have a great night 

Kim
www.codingmastery.com


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