# help with coding this procedure?



## Jenannurb (Mar 30, 2017)

I would love some input as to how to code this procedure.

Op report as below:

Procedure: ERCP with* Sphincterotomy, stone extraction

Date of Procedure: 3/29/2017

Pre-operative Diagnosis: cbd stones, failure of biliary drainage on intraoperative cholangiogram

Sedation: GETA, gentamycin, indomethacin

ASA Class: 3

Mallampati Class:III (soft and hard palate and base of uvula visible)

Procedure Details 

Informed consent was obtained for the procedure, including conscious sedation. Risks including infection, perforation, hemorrhage, adverse drug reaction and aspiration and pancreatitis were discussed. The patient was placed in the left lateral simiprone position.* Based on the pre-procedure assessment, including review of the patient's medical history, medications, allergies, and review of systems, she had been deemed to be an appropriate candidate for mac sedation.* She was monitored continuously with ECG tracing, pulse oximetry, blood pressure monitoring, and direct observation.
* *
The duodenoscope was inserted into the mouth and advanced under direct vision to the second portion of the duodenum. 

Findings:

Survey of the esophagus, stomach and duodenum was normal.* 

The major papilla was identified in the second portion of the duodenum.* A Microvasive Hydrotome catheter was positioned just inside the major papilla. 

A guidewire was advanced into the common bile duct under fluoroscopic guidance without the need for contrast injection.* The catheter was then advanced over the wire into the region of the common bile duct.* Next a cholangiogram was obtained
.
This demonstrated distal filling defects.
A sphincterotomy was performed.* Next balloon used to extract 3 cholesterol stones. F/u imaging showed no extraluminal air/contrast, good drainage. The patient tolerated the procedure well.

Impression:* *
Choledocholithiasis s/p ercp/sphincterotomy/stone extraction


**I am thinking that it gets a 43264 and a 43277

any help would be great!

Jennifer


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## GastroGal (Mar 31, 2017)

i would use only the 43264 for the stone removal, i would not use the 43277 if he did not dilate a biliary duct or the ampulla of Vater.


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## makristinenapa@gmail.com (Mar 31, 2017)

Agree with 43264 alone


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## afalcon@dhcla.com (Apr 3, 2017)

use only 43264


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## clarkmegan (Apr 4, 2017)

Jenannurb said:


> I would love some input as to how to code this procedure.
> 
> Op report as below:
> 
> ...



I would code 43264 (balloon sweep) and 43262 (for the sphincterotomy).  43277 is considered inclusive to 43264 as it applies to dilating, but the sphincterotomy is separately billable.  As is fluoroscopic interpretation if no radiologist was present.

My codes would be:

43264
43262
74328-26 (if applicable)


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