Wiki OP Note assistance

[AthensCoder]

Hello all,

I'm in need of some assistance withe coding the below report. It has me a little confused due to the scope only went to the duodenum, but the report also states "Papillotome was used for cannulation and a cholangiogram was obtained and showed no filling defects". I'm thinking 43247 and not sure on the cannulation. Any assistance would be great!

PROCEDURE PERFORMED: Endoscopic Retrograde cholangiopancreatography with stent removal.

PREOPERATIVE DIAGNOSIS: Bile leak after laparoscopic cholecystectomy

POSTOPERATIVE DIAGNOSIS: Normal cholangiogram

PROCEDURE: Olympus sided viewing duodenoscope was inserted into the patient's mouth and advanced down to the descending duodenum. The stent was noted to be protruding the ampulla. A snare was placed through the endoscope and the tip of the stent was grasped. The scope was withdrawn, and this pilled the stent up through the patient's esophagus and out the patient's mouth. The scope was then reintroduced back into the descending duodenum. Papillotome was used for cannulation and a cholangiogram was obtained and showed no filling defects. The common bile duct appeared normal in caliber. There was no evidence of any bile leak. The scope was removed and no immediate postprocedure complications.

Thanks in advance for any help!!

 

[doxie1064]

ERCP with stent removal and cholangiogram

I would use CPT code 43275 (ERCP with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) and my reasoning is that he went back in and "cannulated" for cholangiogram (examination of the bile ducts, used to identify filling defects/obstruction) which is CPT code 74328. Since the ducts were cannulated for the cholangiogram, the requirement of an ERCP is met. [An ERCP is considered complete if one or more of the ductal systems (pancreatic/biliary) is visualized. To report an attempted ERCP with unsuccessful cannulation use, EGD codes] I'm actually not sure the same provider can bill a cholangiogram code and an EGD code together without an ERCP code since the cholangiogram code itself implies cannulation; I've never come across that scenario. Some facilities allow the physician to bill for the cholangiogram (74328) using modifier 26 if he/she interpreted the results themselves but others use global billing and bill out using no modifiers with the facility charges. I code for one corporation and 2 sites use the global model while 1 site uses the modifiers. Best of Luck!