Wiki ERCP or EGD?

clarkmegan

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Intended procedure was ERCP but note states they were not able to successfully cannulate. However, the note says partial cholangiogram and pancreatogram performed. Which code is more appropriate to bill? 43235 or 43260?

"Upon passing into the pylorus, there were two very large periampullary diverticula. Ultimately, the ampulla was able to be identified, although it
was in a very difficult position.I was able to better get a view of the ampulla, although it was still difficult to get in a good position. We were able to initially get a small pancreatogram, which appeared normal. A partial cholangiogram was performed, again with the scope in the long position, and there appeared
to be a stone. There was also pus coming from the bile duct. Unfortunately due to the positioning, I was unable to get a wire into the bile duct to advance the sphincterotome to make a sphincterotomy and place a stent or remove the stone. We tried a differentcatheter with a 39 mm sphincterotome, which was unsuccessful. We also placed the patient in the left lateral decubitus position and in the supine position to try to get better access and view, both of which were unsuccessful. After two hours of attempts, unable to successfully get an adequate wire cannulation and place a stent, I aborted the procedure"
 
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With that documentation I would use 43260, but possibly use a modifier such as 52 or 53. I would have checked with the provider if they believe it was a reduced service or discontinued procedure (I am swaying more towards 53).
 
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