hcg
Guru
I am having a hard time looking for a CPT code for EGD with sclerotherapy for pyloric channel ulcer. My doctor performed EGD with biopsy & sclerotherapy to a patient who was having GI bleed & hematemesis. Here's his report:
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INDICATIONS
This is a 48 year old pt admitted to the hospital with acute gastrointestinal bleed following a significant consumption of ibuprofen. Patient received a transfusion and was stabilized in the intensive care unit. I recommended endoscopic evaluation. Risks of the procedure, including bleeding, infection, failure to find the source of the bleeding as well as the risks of anesthesia, were discussed and the patient's questions were answered.
OPERATIVE PROCEDURE
The patient was identified, brought to the endoscopy room placed in the left lateral decubitus position. Intravenous sedation was achieved by the anesthesia service. Videoscopic gastroscope was passed without difficulties through the cricopharyngeus under direct vision throughout the length the esophagus and down into the stomach. Pylorus was cannulated. Duodenum was examined to its 3rd portion and felt to be normal in its entirety. The scope was pulled back into the stomach. There were 2 adjacent pyloric channel ulcers, neither of which was actively bleeding; however, there was an inherent and a visible vessel on the proximal of the 2 ulcers. I chose to inject this with sclerotherapy, making 4 quadrant injections around this ulcer with epinephrine and a 1:10,000 dilution. An additional injection was made into the ulcer crater itself.
There was no evidence of active bleeding. Biopsies were obtained of the antrum in an area adjacent to but not adjacent contiguous with the ulcer. The scope was then retroflexed. The cardia and the fundus of the stomach appeared to be normal. The scope was pulled back into the esophagus which was also felt to be normal. The scope was then removed. The patient tolerated the procedure without difficulties.
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The injection code I know was for esophageal/gastric varices (43243). I couldn't find a code for this injection. Hope you can help me.
Thank you.
**********************************************************
INDICATIONS
This is a 48 year old pt admitted to the hospital with acute gastrointestinal bleed following a significant consumption of ibuprofen. Patient received a transfusion and was stabilized in the intensive care unit. I recommended endoscopic evaluation. Risks of the procedure, including bleeding, infection, failure to find the source of the bleeding as well as the risks of anesthesia, were discussed and the patient's questions were answered.
OPERATIVE PROCEDURE
The patient was identified, brought to the endoscopy room placed in the left lateral decubitus position. Intravenous sedation was achieved by the anesthesia service. Videoscopic gastroscope was passed without difficulties through the cricopharyngeus under direct vision throughout the length the esophagus and down into the stomach. Pylorus was cannulated. Duodenum was examined to its 3rd portion and felt to be normal in its entirety. The scope was pulled back into the stomach. There were 2 adjacent pyloric channel ulcers, neither of which was actively bleeding; however, there was an inherent and a visible vessel on the proximal of the 2 ulcers. I chose to inject this with sclerotherapy, making 4 quadrant injections around this ulcer with epinephrine and a 1:10,000 dilution. An additional injection was made into the ulcer crater itself.
There was no evidence of active bleeding. Biopsies were obtained of the antrum in an area adjacent to but not adjacent contiguous with the ulcer. The scope was then retroflexed. The cardia and the fundus of the stomach appeared to be normal. The scope was pulled back into the esophagus which was also felt to be normal. The scope was then removed. The patient tolerated the procedure without difficulties.
**********************************************************
The injection code I know was for esophageal/gastric varices (43243). I couldn't find a code for this injection. Hope you can help me.
Thank you.