jojogi
Guest
This wording is confusing me. I know that I would code 43262 for the sphincterotomy but I want to code 43264 for the ballon sweep also but since stones are not mentioned I am hesitant to do so. Filling defects could justify the balloon sweep I believe but I am not totally sure. Any suggestions would be appreciated. 
PROCEDURE PERFORMED: Endoscopic retrograde
cholangiopancreatography )ERCP) with sphincterotomy.
INDICATIONS: Elevated liver enzymes.
REFERRING PHYSICIAN:
INSTRUMENT: Olympus duodenoscope.
MEDICATIONS: Demerol 150 mg, Versed 6 mg IV, glucagon 0.75 mg, and
Phenergan 25 mg IV.
COMPLICATIONS: None.
TECHNIQUE: The patient gave informed consent, after the risks and benefits
were explained to the patient. The patient was placed in the prone
position and conscious sedation was obtained using the above medication.
The endoscope was introduced and advanced to the second portion of the
duodenum under direct visualization.
FINDINGS: The major papilla looked normal and there was unremarkable gas
pattern on the scout film. The common bile duct was cannulated with .035
guidewire, using a microvasive sphinctertome.
CHOLANGIOGRAM: The initial cholangiogram showed a few filling defects, but
were possibly air bubbles. An exchange with the balloon catheter was
performed and an occlusion cholangiogram was performed with balloon sweep
and that confirmed the ducts are clear. The ducts were normal size and
there was no filling defects seen. Sphincterotomy was performed prior to
the balloon sweep and the site was observed and there was no bleeding.
There was no filling of the gallbladder during our cholangiogram. The
pancreatic duct was not injected or cannulated.
IMPRESSIONS:
1. No filling of the gallbladder. Otherwise, normal cholangiogram.
2. Status post balloon sweep that confirmed the ducts are clear.
3. Status post sphincterotomy.
RECOMMENDATIONS: Proceed with surgery for acute cholecystitis
PROCEDURE PERFORMED: Endoscopic retrograde
cholangiopancreatography )ERCP) with sphincterotomy.
INDICATIONS: Elevated liver enzymes.
REFERRING PHYSICIAN:
INSTRUMENT: Olympus duodenoscope.
MEDICATIONS: Demerol 150 mg, Versed 6 mg IV, glucagon 0.75 mg, and
Phenergan 25 mg IV.
COMPLICATIONS: None.
TECHNIQUE: The patient gave informed consent, after the risks and benefits
were explained to the patient. The patient was placed in the prone
position and conscious sedation was obtained using the above medication.
The endoscope was introduced and advanced to the second portion of the
duodenum under direct visualization.
FINDINGS: The major papilla looked normal and there was unremarkable gas
pattern on the scout film. The common bile duct was cannulated with .035
guidewire, using a microvasive sphinctertome.
CHOLANGIOGRAM: The initial cholangiogram showed a few filling defects, but
were possibly air bubbles. An exchange with the balloon catheter was
performed and an occlusion cholangiogram was performed with balloon sweep
and that confirmed the ducts are clear. The ducts were normal size and
there was no filling defects seen. Sphincterotomy was performed prior to
the balloon sweep and the site was observed and there was no bleeding.
There was no filling of the gallbladder during our cholangiogram. The
pancreatic duct was not injected or cannulated.
IMPRESSIONS:
1. No filling of the gallbladder. Otherwise, normal cholangiogram.
2. Status post balloon sweep that confirmed the ducts are clear.
3. Status post sphincterotomy.
RECOMMENDATIONS: Proceed with surgery for acute cholecystitis