twomack
New
Hello All,
I was wondering if you could provide your input on how you would code this: Thanks! Tammie
After informed consent patient was brought to the interventional radiology room, placed in the prone position. General anesthesia was provided by anesthesiologist. Then the Olympus TGF duodenoscope was passed orally into the esophagus, stomach and duodenum. Esophagus, patient is status post esophagectomy for esophageal cancer with gastric pull-up. Stomach was filled with food and it was difficult to get into the duodenum. Second portion of the duodenum showed plastic biliary stent. The old biliary stent on left side was not to be found. The right hepatic duct stent was removed to snare. Then cholangiogram was performed. There is complete occlusion of the common hepatic duct proximally with very little contrast going into the left hepatic duct and right hepatic duct. A wire was passed into the left hepatic duct and locked. I was unable to get any contrast significantly through the stricture in the left hepatic duct. Then the sphincterotome was removed and another wire was passed into the right hepatic duct. Good cholangiogram was obtained which showed evidence of right hepatic duct stricture. It was decided to potu a 10-French 12 cm stent in the right hepatic duct stricture. The stent was placed above the stricture. The stent was placed above the stricture. Good flow of bile was obtained postprocedure. Then I attempted to dilate the left hepatic duct stricture with a 4x4 biliary balloon. However I was unable to get the balloon above the stricture or significantly into the stricture. The balloon was removed. Taper-tip cannula was then attempted to be passed into the strictured area. I was able to get it almost beyond the stricture. However, I was unable to get it past the stricture and cholangiogram did show the filling of the left hepatic secondary and tertiary radicles. The tapper-tip cannula was removed. Initially a 7-French 9 cm stent was attempted to be replaced. However, the stent was too short. Thereafter a 7-French 12 cm stent was passed into the left hepatic duct stricture with great difficulty. I was unable to get the stent beyond the stricture into the dilated hepatic radicles. Good flow of bile, however, was obtained through the left hepatic duct sent. Gallbladder did fill.
IMPRESSION:
Right and left hepatic duct strictures, the left hepatic duct stricture being tighter than on the right. Definite complete stenting of the right hepatic duct stricture obtained. However, left hepatic duct stricture was not completely traversed.
I was wondering if you could provide your input on how you would code this: Thanks! Tammie
After informed consent patient was brought to the interventional radiology room, placed in the prone position. General anesthesia was provided by anesthesiologist. Then the Olympus TGF duodenoscope was passed orally into the esophagus, stomach and duodenum. Esophagus, patient is status post esophagectomy for esophageal cancer with gastric pull-up. Stomach was filled with food and it was difficult to get into the duodenum. Second portion of the duodenum showed plastic biliary stent. The old biliary stent on left side was not to be found. The right hepatic duct stent was removed to snare. Then cholangiogram was performed. There is complete occlusion of the common hepatic duct proximally with very little contrast going into the left hepatic duct and right hepatic duct. A wire was passed into the left hepatic duct and locked. I was unable to get any contrast significantly through the stricture in the left hepatic duct. Then the sphincterotome was removed and another wire was passed into the right hepatic duct. Good cholangiogram was obtained which showed evidence of right hepatic duct stricture. It was decided to potu a 10-French 12 cm stent in the right hepatic duct stricture. The stent was placed above the stricture. The stent was placed above the stricture. Good flow of bile was obtained postprocedure. Then I attempted to dilate the left hepatic duct stricture with a 4x4 biliary balloon. However I was unable to get the balloon above the stricture or significantly into the stricture. The balloon was removed. Taper-tip cannula was then attempted to be passed into the strictured area. I was able to get it almost beyond the stricture. However, I was unable to get it past the stricture and cholangiogram did show the filling of the left hepatic secondary and tertiary radicles. The tapper-tip cannula was removed. Initially a 7-French 9 cm stent was attempted to be replaced. However, the stent was too short. Thereafter a 7-French 12 cm stent was passed into the left hepatic duct stricture with great difficulty. I was unable to get the stent beyond the stricture into the dilated hepatic radicles. Good flow of bile, however, was obtained through the left hepatic duct sent. Gallbladder did fill.
IMPRESSION:
Right and left hepatic duct strictures, the left hepatic duct stricture being tighter than on the right. Definite complete stenting of the right hepatic duct stricture obtained. However, left hepatic duct stricture was not completely traversed.